权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Management of Post-Surgical Febrile Responses by Anesthetic Drugs.

麻醉药物治疗术后发热反应。

基本信息

批准号：
11470328
负责人：
OZAKI Makoto
金额：
$ 5.7万
依托单位：
Tokyo Women's Medical University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
1999
资助国家：
日本
起止时间：
1999 至 2002
项目状态：
已结题

项目摘要

The mechanism and clinical relevance of increased core temperature (Tc) after surgery are poorly understood. Because fever is used as a diagnostic sign of infection, it is important to recognize what constitutes the normal postoperative thermoregulatory response. In the current study the authors tested the hypothesis that a regulated increase in Tc setpoint occurs after surgery. We studied 271 patients in the first 24 h after a variety of vascular, abdominal, and thoracic surgical procedures. Tc measured in the urinary bladder, skin-surface temperatures, thermoregulatory responses (vasoconstriction and shivering), and total leukocyte counts were assessed. In a subset of 34 patients, plasma concentrations of tumor necrosis factor, interleukin (IL)-6, and IL-8 were measured before and after surgery. In the early postoperative period, the maximum increase in Tc above the preoperative baseline averaged 1.4 ± 0.8°C (2.5 ± 1.4°F), with the Tc peak occurring 11.1 ± 5.8 h after surgery. Fifty percent of patients had a maximum Tc greater than or equal to 38.0°C (100.4°F) and 25% had a maximum Tc greater than or equal to 38.5°C (101.3°F). The progressive postoperative increase in Tc was clearly associated with cutaneous vasoconstriction and shivering, indicating a regulated elevation in Tc setpoint. The elevated Tc was associated with an increased IL-6 response but not with leukocytosis. Maximum postoperative Tc was positively correlated with duration and extent of the surgical procedure. A regulated elevation in Tc setpoint (fever) occurs normally after surgery. The association between Tc elevation, extent and duration of surgery, and the cytokine response suggests that early postoperative fever is a manifestation of perioperative stress.

手术后核心温度（Tc）升高的机制和临床相关性知之甚少。由于发热被用作感染的诊断标志，因此认识到正常的术后体温调节反应是很重要的。在当前研究中，作者检验了手术后Tc设定点发生调节性升高的假设。我们研究了271例患者在各种血管、腹部和胸部手术后的前24小时。测定膀胱Tc、皮肤表面温度、体温调节反应（血管收缩和寒战）和总白细胞计数。在一个34例患者的亚组中，在手术前后测量肿瘤坏死因子、白细胞介素（IL）-6和IL-8的血浆浓度。术后早期，Tc较术前基线的最大增幅平均为1.4 ± 0.8°C（2.5 ± 1.4°F），Tc峰值出现在术后11.1 ± 5.8小时。50%的患者最大Tc大于或等于38.0°C（100.4°F），25%的患者最大Tc大于或等于38.5°C（101.3°F）。Tc的进行性术后增加与皮肤血管收缩和寒战明显相关，表明Tc设定点的调节性升高。Tc升高与IL-6反应增加相关，但与白细胞增多无关。术后最大Tc与手术时间和范围呈正相关。手术后正常会出现Tc设定点（发热）的调节性升高。Tc升高、手术范围和持续时间以及细胞因子反应之间的相关性表明，术后早期发热是围手术期应激的表现。