Management of Post-Surgical Febrile Responses by Anesthetic Drugs.

术后中心体温升高的机制和临床相关性尚不清楚。由于发热被用作感染的诊断标志，因此重要的是要认识到什么是构成术后正常体温调节反应的因素。在目前的研究中，作者检验了一种假设，即手术后TC设定点会有规律性的增加。我们研究了271名患者在接受各种血管、腹部和胸部外科手术后的前24小时内。测量膀胱总胆固醇、皮肤表面温度、体温调节反应(血管收缩和颤抖)和白细胞总数。对34例患者进行手术前后血浆肿瘤坏死因子、白介素6和白介素8浓度的检测。术后早期最大上升幅度为1.4±0.8°C(2.5±1.4°F)，峰值出现在术后11.1±5.8h。50%的患者最大Tc值大于或等于38.0°C(100.4°F)，25%的患者最大Tc值大于或等于38.5°C(101.3°F)。术后体温进行性升高与皮肤血管收缩和寒战明显相关，提示体温设定点有规律性升高。T_c升高与IL-6反应增加有关，但与白细胞增多无关。术后最大TC与手术时间和手术范围呈正相关。术后体温设定值(发热)正常升高。TC升高、手术范围和手术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一种表现。

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.