腫瘍型膝関節全摘術患者における全身麻酔と脊椎麻酔の全身炎症反応に対する有効性と安全性

The Effectiveness and Safety of General and Spinal Anesthesia on Systemic Inflammatory Response in Patients with Tumor-Type Total Knee Arthroplasty.

• Qiang Wang
• Fei Lin
• Bin Huang
• Ling Hui Pan

抄録

背景:

腫瘍型全膝関節形成術(TKA)における麻酔処置は、全身の炎症反応に寄与する可能性がある。そこで、腫瘍型TKA患者における全身麻酔と脊椎麻酔の有効性と安全性を検討することを目的としている。

BACKGROUND: The anesthesia procedure in tumor-type total knee arthroplasty (TKA) may contribute to systemic inflammatory response. Therefore, we aim to investigate the effectiveness and safety of general and spinal anesthesia in patients with tumor-type TKA.

患者および方法:

原発性片側性TKAを受けた膝周囲に腫瘍のある患者25人を、全身麻酔群（n = 13）と脊髄麻酔群（n = 12）に無作為に分けた。膝関節HSSスコアとWestern Ontario and McMaster University ostststeoarthritis index（WOMAC変形性膝関節症）を術前と術後12ヵ月後に記録した。ビジュアルアナログスケール、Ｃ反応性蛋白（ＣＰＲ）、腫瘍壊死因子-α（ＴＮＦ-α）、インターロイキン-８（ＩＬ-８）濃度を術前（Ｔ０）、手術当日（Ｔ１）、手術後１日目（Ｔ２）に測定した。両群の合併症を記録した。

PATIENTS AND METHODS: Twenty-five patients with tumors around the knee undergoing primary unilateral TKA were randomly divided into the general anesthesia group (n = 13) and spinal anesthesia group (n = 12). Knee joint HSS scores and Western Ontario and McMaster University osteoarthritis index (WOMAC osteoarthritis) were recorded before surgery and 12 months after surgery. Visual analogue scale, C-reactive protein (CPR), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8) concentration were measured preoperatively (T0), on the day of the operation (T1), and on the first day (T2) after the operation. Complications in the two groups were recorded.

結果:

手術時間、術中出血、術後ドレナージ、止血時間、合併症率は全身麻酔群と脊椎麻酔群で有意差はなかった（いずれもp＞0.05）。CPRには有意差はなかった（7.6±3.1、8.1±4.1、91.3±24.2 vs. 7.1±2.9、7.6±3.2、7.6±3.1、8.1±4.1、91.3±24.2。8、85.1±19.3 pg/mL、それぞれ）、IL-8（12.2±6.6、13.4±7.3、19.2±10.5 vs. 11.9±5.7、12．9±8.6、22.2±12.4 pg/mL、それぞれ）、およびTNF-α（2.5±1.7、2.2±1.9、2.8±2.1 vs. 2．4±1.3、2.7±2.1、2.9±1.6 pg/mL、それぞれ）をT0、T1およびT2での両群間で比較した（いずれもp＞0.05）。術前および術後のHSS膝スコアには統計的差はなかった（39.78±11.3、90.24±15.3 vs. 42.68±12.5、91．21±16.3）およびWOMAC指数（49.89±7.9、25.12±6.2 vs. 51.3±8.3、23.15±5.3）を両群間で比較した（p＞0.05）。

RESULTS: The operative time, intraoperative blood loss, postoperative drainage, tourniquet time, and complication rate were not significantly different between the general anesthesia and spinal anesthesia groups (all p > 0.05). There were no significant differences in CPR (7.6 ± 3.1, 8.1 ± 4.1, 91.3 ± 24.2 vs. 7.1 ± 2.9, 7.6 ± 3.8, 85.1 ± 19.3 pg/mL, respectively), IL-8 (12.2 ± 6.6, 13.4 ± 7.3, 19.2 ± 10.5 vs. 11.9 ± 5.7, 12.9 ± 8.6, 22.2 ± 12.4 pg/mL, respectively), and TNF-α (2.5 ± 1.7, 2.2 ± 1.9, 2.8 ± 2.1 vs. 2.4 ± 1.3, 2.7 ± 2.1, 2.9 ± 1.6 pg/mL, respectively) between the two groups at T0, T1, and T2 (all p > 0.05). There were no statistical differences in pre- and postoperative HSS knee scores (39.78 ± 11.3, 90.24 ± 15.3 vs. 42.68 ± 12.5, 91.21 ± 16.3) and WOMAC indexes (49.89 ± 7.9, 25.12 ± 6.2 vs. 51.3 ± 8.3, 23.15 ± 5.3) between the two groups (p > 0.05).

結論:

腫瘍型TKA患者における全身麻酔と脊髄麻酔は同等の有効性と安全性を有していた。

CONCLUSION: General anesthesia and spinal anesthesia in patients with tumor-type TKA had the same effectiveness and safety.

© 2020 S. Karger AG, Basel.