J.Jpn. Surg. Soc.. 91(9): 1170-1173, 1990

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Report on the annual meeting

SURGICAL STRESS AND BIOLOGICAL REACTIONS: PROTECTIVE OR NOT

Postoperative changes of blood levels of epinephrine, norepinephrine, CRP, α₁ protease inhibitor (α₁ PI), transferrin (Tf) and granulocyte (PMN) elastase, and superoxide production by PMN were studied in ninety-three patients with esophageal carcinoma (M: 81, F: 12, 61±8y/o) in reference to postoperative pulmonary function (PaO₂/FiO₂), in order to elucidate the significance of biological reactions in postoperative stress condition.
Superoxide production of PMN and elastase increased up to the third day and correlated reversely with PaO₂/FiO₂ (y=0.046x+440, r=－0.67, p＜ 0.001 : y=－0.25x+443, r=－0.60, p＜0.05, respectively). In acute phase of 1ー3 days postoperation, α₁ PI and CRP appeared to correlate with PaO₂/FiO₂ and the CRP of the second day when CRP increased maximum correlated with PaO₂/FiO₂ (y = 2.5x + 217, r = 0.55, p＜ 0.01). When serum level of CRP increased above 20mg/dl, PMN superoxide production was suppressed. CRP level did not exceed the maximum CRP value at norepinephrine concentration of 0.5ー0.7ng/ml, when norepinephrine level was increased more.
Conclusion : Granulocyte functions were increased in postoperative course of esophagectomy and correlated with pulmonary dysfunction. But in the acute phase of 1ー3 days postoperation, increased acute phase reactant proteins seemed to suppress granulocyte function and to protect pulmonary function.

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