Optimal Period for the Prophylactic Administration of Neutrophil Elastase Inhibitor for Patients with Esophageal Cancer Undergoing Esophagectomy
Optimal Period for the Prophylactic Administration of Neutrophil Elastase Inhibitor for Patients with Esophageal Cancer Undergoing Esophagectomy
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DOI：
10.1007/s00268-011-1095-6
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发表时间：
2011-07-01
影响因子：
2.6
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
--
作者：
Iwahashi, Makoto;Nakamori, Mikihito;Yamaue, Hiroki
本研究旨在确定经胸食管切除术患者预防性给予中性粒细胞弹性蛋白酶抑制剂西维来司的最佳时间。据报道，西维来司他通过在术后期间提供增加的氧合能力和抑制血清炎性细胞因子，对接受食管切除术的患者有效。然而，预防性使用西维来司他的最佳时间仍有待阐明。方法将30例因胸段食管癌接受食管切除术的患者分为两组。最初的15例患者被分配到A组，接受西维来司他钠水合物静脉输注直至术后第2天（POD），随后的15例患者被分配到B组，接受西维来司他直至术后第5天。使用未给予西维来司的历史对照。结果西维来司他可改善术后氧合，但在机械通气时间、重症监护室时间、全身炎症反应综合征、术后氧合变化方面，两组无差异。此外，血清白细胞介素（IL）-6和高迁移率族蛋白1的术后变化无差异。术后第3天，B组血清IL-8水平低于A组，而中性粒细胞弹性蛋白酶水平无明显差异。两组患者均未发生呼吸系统并发症。结论：胸内操作后立即开始的西维来司他两天给药足以通过抑制食管切除术后的高细胞因子血症来预防肺部并发症。
Background The present study was designed to determine the optimal period for the prophylactic administration of the neutrophil elastase inhibitor, Sivelestat, in patients undergoing transthoracic esophagectomy. Sivelestat is reported to be effective in patients who undergo esophagectomy by providing an increased oxygenation ability and suppressing the serum inflammatory cytokines in the postoperative period. However, the optimal period for the prophylactic administration of Sivelestat remains to be elucidated.Methods The 30 patients who underwent esophagectomy for thoracic esophageal cancer were enrolled in one of two groups. The initial 15 patients were assigned to group A and received intravenous infusion of Sivelestat sodium hydrate until postoperative day (POD) 2, and the subsequent 15 patients were assigned to group B and received Sivelestat until POD 5. Historical controls without Sivelestat administration were used. The postoperative courses and serum inflammatory cytokines were evaluated.Results Sivelestat improved oxygenation in the postoperative period; however, there were no differences between the two groups in terms of duration of mechanical ventilation, intensive care unit stay, systemic inflammatory response syndrome, and postoperative change of oxygenation. In addition, there were no differences in the postoperative changes in the serum interleukin (IL)-6 and high mobility group box chromosomal protein 1. Although the serum IL-8 on POD 3 was lower in group B than in group A, the neutrophil elastase showed no difference between these groups. None of the patients in either group suffered respiratory complications.Conclusions The two-day administration of Sivelestat initiated immediately after intrathoracic manipulation was found to be sufficient for prophylactic use to prevent pulmonary complications by suppressing hypercytokinemia after esophagectomy.