Preincisional intravenous pentoxifylline attenuating Perioperative cytokine response, reducing morphine consumption, and improving recovery of bowel function in patients undergoing colorectal cancer surgery
Preincisional intravenous pentoxifylline attenuating Perioperative cytokine response, reducing morphine consumption, and improving recovery of bowel function in patients undergoing colorectal cancer surgery
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DOI：
10.1213/01.ane.0000132974.32249.c8
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发表时间：
2004-11-01
影响因子：
5.7
通讯作者：
Wu, CT
中科院分区：
文献类型：
--
作者：
Lu, CH;Chao, PC;Wu, CT
手术过程中细胞因子的释放可以产生持久的痛觉过敏。因此，术前给予细胞因子抑制剂可能会减少细胞因子的产生，降低中枢神经系统致敏作用，改善术后疼痛缓解的质量。我们研究了这样一种假设，即在接受择期结直肠癌手术的患者中，术前IV戊氨酰茶碱（PTX）治疗可以减弱促炎性（肿瘤坏死因子、白细胞介素（IL）-1 β、IL-6和IL-8）和TNF（IL-1受体拮抗剂）细胞因子的释放。将40例患者随机分为2组，每组20例：PTX组在麻醉诱导前接受PTX 5 mg/kg TV输注，而对照组接受等体积的生理盐水。频繁采集静脉血样。术后，所有患者均接受患者自控镇痛（PCA）吗啡用于术后疼痛缓解。与对照组相比，PTX组患者的PCA触发时间更长，吗啡消耗量更少，肠功能恢复更快。此外，治疗组中IL-6、IL-8和IL-1受体拮抗剂的血浆水平较低，在2年随访期间，两组之间的伤口感染、肿瘤复发或转移率无显著差异。
Cytokine release during surgery can produce a long-lasting hyperalgesia. Thus, preoperatively-administered cytokine inhibitors might reduce the production of cytokines, decreasing central nervous system sensitization and improving the quality of postoperative pain relief. We investigated the hypothesis that preincisional IV pentoxifylline (PTX) treatment could attenuate the release of proinflammatory (tumor necrosis factor, interleukin (IL)-1beta, IL-6, and IL-8) and antiinflammatory (IL-1 receptor antagonist) cytokines in patients who underwent elective colorectal cancer surgery. Forty patients were randomly assigned to 1 of 2 groups of 20 each: the PTX group received a PTX 5 mg/kg TV infusion before the induction of anesthesia, whereas the control group received an equal volume of normal saline. Venous blood samples were obtained at frequent intervals. After surgery, all patients received patient-controlled analgesia (PCA) morphine for postoperative pain relief. Patients in the PTX group exhibited longer PCA trigger times, less morphine consumption, and a faster return of bowel function compared with patients in the control group. Moreover, the plasma levels of IL-6, IL-8, and IL-1 receptor antagonist were less in the treatment group, and there was no significant difference in wound infections, tumor recurrence, or metastatic rates between groups during a 2-yr follow-up.