甲泼尼龙预防食管癌术后急性呼吸衰竭的疗效研究

The clinical efficacy of methylprednisolone to prevent postoperative acute respiratory failure after oesophageal cancer surgery

目的研究食管癌术后早期应用甲泼尼龙降低急性呼吸衰竭的发生率。方法收集2015年11月至2016年12月泰山医学院附属成武医院胸外科234例行食管癌手术患者的病例资料,食管癌术后早期在常规药物基础上加用80 mg甲泼尼龙治疗为观察组,仅采用常规药物治疗为对照组。将食管癌术后7 d内发生的急性肺损伤、急性呼吸窘迫综合征和肺炎定义为急性呼吸衰竭,比较。结果对照组与观察组一般特征具有可比性。观察组急性呼吸衰竭的发生率较对照组低(P=0.037)。两组患者术后吻合口瘘和吻合口不愈合的发生率差异均无统计学意义(P=0.570,P=1.000)。观察组C-反应蛋白在术后第2天水平较低(P=0.005)。多因素分析显示,食管癌术后早期应用甲泼尼龙是一种保护因素可降低急性呼吸衰竭的发生(P=0.046,OR=0.206)。结论食管癌术后早期应用甲泼尼龙可降低发生急性呼吸衰竭的风险。甲泼尼龙可减轻外科手术应激引起的炎症反应。

Objective This study was performed to investigate whether early postoperative applicationof methylprednisolone can attenuate postoperative respiratory failure. Methods Between November 2005 andDecember 2008, 234 consecutive patients who underwent an oesophagectomy for oesophageal cancer were re.viewed. In the steroid group, an 80 mg dose of methylprednisolone was administered after performing the anasto.mosis. In the control group, only ordinary drugs were performed. Acute lung injury （ALI）, acute respiratorydistress syndrome （ARDS） and pneumonia occurring before postoperative day （POD） 7 were regarded as acuterespiratory failure. The incidence of acute respiratory failure was compared between the two groups. ResultsPatients’ characteristics were comparable. The incidence of acute respiratory failure was lower in the steroidgroup （P= 0. 037）. The incidences of anastomotic leakage and wound dehiscence were not different （P= 0. 570and P= 1. 000）. The C.reactive protein level on POD 2 was lower in the steroid group （P= 0. 005）. Multivari.ate analysis indicated that the intraoperative steroid was a protective factor against acute respiratory failure （P=0. 046, OR = 0. 206 ） . Conclusions Intraoperative corticosteroid administration was associated with a decreased risk of acute respiratory failure following an oesophagectomy. The laboratory data suggest that cortico.steroids may attenuate the stress.induced inflammatory responses after surgery.