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目的探讨围手术期细胞因子和应激激素的变化规律及其临床意义。方法 96.3～96.12中山一院外科Ⅱ、Ⅲ期胃癌(A 组)13例,低位直肠癌(B 组)13例和食管贲门癌(C 组)11例,均接受根治性切除术,对照组(10例)为择期小手术。所有患者于术前1日、术后2小时、术后1日和术后6日取血,测定血浆中 IL-6,IL-8,ACTH,Cortisol 含量。结果 A、B、C 三组患者术后2小时 IL-6、IL-8、ACTH、Cortisol 含量显著升高(P<0.05),但各组上升幅度不同,术后1日则显著下降。出现并发症患者 IL-6和 IL-8呈过度升高,而对照组仅ACTH 显著升高(P<0.05)。结论围手术期细胞因子和应激激素的变化具有显著时效性,监测其变化有利于判断手术创伤程度和予后,具有显著临床意义。
Objective To investigate the regularity and clinical significance of changes in cytokines and stress hormones during perioperative period. Methods 96.3～96.12 Zhongshan First Hospital surgical stage II and III gastric cancer (group A) 13 cases, low rectal cancer (group B) 13 cases and esophageal and cardiac cancer (group C) 11 cases, all underwent radical resection, control group ( 10 cases) for elective minor surgery. All patients were bled at 1 day before operation, 2 hours after operation, 1 day after operation and 6 days after operation. Plasma IL-6, IL-8, ACTH, and Cortisol levels were measured. Results The levels of IL-6, IL-8, ACTH, and Cortisol in the three groups of patients A, B, and C increased significantly (P<0.05) at 2 hours postoperatively. However, the increase was different in each group, and decreased significantly on the 1st day after surgery. In patients with complications, IL-6 and IL-8 were excessively elevated, whereas in the control group only ACTH was significantly increased (P<0.05). Conclusion The changes of cytokines and stress hormones during the perioperative period have significant timeliness. Monitoring their changes is helpful for judging the degree of surgical trauma and its subsequent clinical significance.