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Primäre und sekundäre freisetzung von interleukin 6 und 8 bei der gestuften polytraumaversorgung

Primary and secondary release of interleukines 6 and 8 during staged treatment of multiple trauma patients

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Zusammenfassung

Der polytraumatisierte Patient entwickelt wegen der unfallbedingten Kombination aus Schock, Weichteilschaden, Organverletzungen und Frakturen regelmäßig ein systemisches Entzündungssyndrom mit dem Risiko eines Multiorganversagens. Zur Minimierung der Belastung mit proinflammatorischen Mediatoren hat sich daher ein gestuftes Versorgungskonzept polytraumatisierter Patienten mit Primärstabilisierung aller relevanten Frakturen und Weichteilschäden und einer zeitlichen Aufschiebung sekundärer Rekonstruktionen oder Verfahrenswechsel durchgesetzt.

Ziel dieser prospektiven klinischen Studie war die Evaluation der durch Sekundäreingriffe verursachten konsekutiven Entzündungsstimulation in Abhängigkeit vom Zeitpunkt ihrer Durchführung. Hierzu wurden die proinflammatorischen Zytokine Interleukin (IL) 8 und IL-6 am Tag vor und nach einem operativen Eingriff in der vulnerablen Phase bis Tag 5 und danach analysiert.

Die Auswertung der Plasmaspiegel der Zytokine IL-8 und IL-6 zeigte, daß operative Eingriffe zwischen Tag 2 und 5 eine wesentlich ausgeprägtere proinflammatorische Antwort als Eingriffe ab dem sechsten Tag verursachen. Zwischen dem zweiten und fünften Tag boten postoperativ 14 von 26 Patienten erhöhte IL-8-Werte und neun von 27 erhöhte IL-6-Werte. Im Vergleich hierzu wurden nach dem sechsten Tag für IL-8 nur noch bei fünf von 28 Patienten (p = 0,017) und für IL-6 bei zehn von 30 Patienten erhöhte postoperative Werte festgestellt. Diejenigen Patienten, die außerhalb des gestuftes Versorgungskonzepts als Notfall großen Eingriffen zwischen Tag 2 und 5 unterzogen wurden mußten, hatten signifikant höhere Werte im Multiorganversagen-Score als Patienten mit geplanten kleineren Eingriffen im gleichen Zeitintervall (p = 0,001).

Die beobachteten Veränderungen der proinflammatorischen Zytokine IL-8 und IL-6 bestätigen eindrücklich das Konzept der gestuftes Polytraumaversorgung.

Abstract

The combination of shock, soft tissue damage, organ injury and fractures in patients with multiple trauma is responsible for the development of the systemic inflammatory response and multiple organ failure. To minimize the release of proinflammatory mediators a staged treatment of patients suffering from multiple trauma has been established. This includes immediate stabilization of long bone fractures and treatment of soft tissue injuries with definitive osteosynthesis or secondary reconstructive surgery following later on.

The aim of this prospective study was to evaluate the influence of consecutive surgery on the stimulation of proinflammatory mediators, depending on the timepoint of operation. Therefore, interleukine (IL) 8 and IL-6 plasma levels were measured the day before and the day after surgery.

We found that the proinflammatory response was increased markedly when surgery was performed between day 2 and 5 in comparison with surgery between day 6 and 28. Surgery between day 2 to 5 after trauma caused an increase in IL-8 values in 14 out of 26 patients, in contrast only 5 out of 28 showed an increase when surgery was performed after day 6. Significant changes of the IL-6 response following surgery was not observed between the 2 time periods. The patients undergoing unscheduled surgery between days 2 to 5 because of vital indications had significant higher multiple organ failure-scores than those with elective minor surgery in the respective period.

In conclusion, our results stress the importance of a staged treatment of patients suffering from multiple trauma furthermore.

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Literatur

  1. Anderson BO, Harken AH. Multiple organ failure: inflammatory priming and activation sequences promote autogenous tissue injury. J Trauma 1990;30:44.

    Google Scholar 

  2. Ayala A, Chaudry I. Immune dysfunction in murine polymicrobal sepsis: mediators, macrophages, lymphocytes and apoptosis. Shock 1996;6:27–38.

    Google Scholar 

  3. Baggiolini M, Loetscher P, Moser B. Interleukin-8 and the chemokine family. Int J Immunopharmacol 1995;17:103–8.

    Google Scholar 

  4. Bane AE. Multiple organ failure, multiple organ dysfunktion syndrome, and the systemic inflammatory response syndrome. Where do we stand? Shock 1994;2:385–97.

    Google Scholar 

  5. Bone RC. Why the sepsis trail failed. JAMA 1996;276:565–5.

    Google Scholar 

  6. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of inovative therapies in sepsis. The ACCT/SCCM Consensus Conference Committee, American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644–56.

    Google Scholar 

  7. Donnelly SC, Stricter R, Kunkel S, et al. Interleukin-8 and development of adult respiratory distress syndrome in at-risk patient group. Lancet 1993;341:643–7.

    Google Scholar 

  8. Ertel W, Kell M, Marty D, et al. Bedeutung der Ganzkörperinflammation bei 1278 Traumapatienten. Unfallchirurg 1998;101:520–6.

    Google Scholar 

  9. Ertel W, Trentz O. Polytrauma und Multiorgan-Dysfunktionssyndrom (MODS). Definition — Pathophysiologie — Therapie. Zentralbl Chir 1994;119:159–67.

    Google Scholar 

  10. Goris RJA, te Boekhorst TPA, Nuytinck JKS, et al. Multipleorgan failure. Generalized autodistructive inflammation? Arch Surg 1985;120:1109–15.

    Google Scholar 

  11. Goris RJA. Mediators of multiple organ failure. Intens Care Med 1990;16:Suppl 3:192–6.

    Google Scholar 

  12. Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J 1990;265:621–36.

    Google Scholar 

  13. Maier M, Rose S, Frank J, et al. Predictive value of circulating mediators in posttraumatic organ failure. J Trauma (in press).

  14. Marzi I, Rose S. Strategie der operativen Versorgung des Polytraumas. Zentralbl Chir 1996;121:950–62.

    Google Scholar 

  15. Marzi I, Bühren V, Schüttler A, et al. Value of superoxide dismutase for prevention of multiple organ failure after multiple trauma. J Trauma 1993;30:110–20.

    Google Scholar 

  16. Marzi I, Mutschler WE. Pathohphysiologie des Traumas und Reparaturmechanismen. In: Praxis der Unfallchrurgie. Stuttgart: Thieme, 1998:17–54.

    Google Scholar 

  17. Nast-Kolb D, Waydhas C, Gippner-Steppert C, et al. Indicators of posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries. J Trauma 1997;42:446–54.

    Google Scholar 

  18. Patrick DA, Moore FA, Moore EE, et al. The inflammatory profile of interleukin-6, interleukin-8, and soluble intercellular adhesion molekule-1 in post-injury multiple organ failure. Am J Surg 1996;172:425–31.

    Google Scholar 

  19. Pleines UE, Stover JF, Kossmann T, et al. Soluble ICAM-1 in CSF coincides with the extent of cerebral damage in patients with severe traumatic brain injury. J Neurotrauma 1998;15:399–409.

    Google Scholar 

  20. Regel G, Lobenhofer P, Grotz M, et al. Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German level I trauma center. J Trauma 1995;38:70–8.

    Google Scholar 

  21. Regel G, Gortz M, Weltner T, et al. Pattern of organ failure following severe trauma. World J Surg 1996;20:422–9.

    Google Scholar 

  22. Regel G, Pohlemann T, Krettek C, et al. Frakturversorgung beim Polytrauma. Unfallchirurg 1997;100:234–48.

    Google Scholar 

  23. Rose S, Marzi I. Pathophysiologie des Polytraumas. Zentralbl Chir 1996;121:896–913.

    Google Scholar 

  24. Roumen RM, Hendriks T, van der Ven Jongekrijg J, et al. Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure. Ann Surg 1993;218:769–76.

    Google Scholar 

  25. Schlag G, Redl H. Mediators of injury and inflammation. World J Surg 1996;20:406–10.

    Google Scholar 

  26. Seekamp A, Jochum M, Ziegler M, et al. Cytokines and adhesion molekules in elective and accidental trauma-related ischemia/reperfusion. J Trauma 1998;44:874–82.

    Google Scholar 

  27. Trentz O. Management of patients with multiple injuries. Ther Umschau 1993;50:491–509.

    Google Scholar 

  28. Waydhas C, Nast-Kolb D, Trupka A, et al. Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. J Trauma 1996;40:624–31.

    Google Scholar 

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Authors and Affiliations

  1. Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik, D-66421, Homburg/Saar

    Ingo Marzi

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  1. Bernd Maier
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  2. Johannes Frank
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  3. Stefan Rose
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  4. Ingo Marzi
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Correspondence to Ingo Marzi.

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Maier, B., Frank, J., Rose, S. et al. Primäre und sekundäre freisetzung von interleukin 6 und 8 bei der gestuften polytraumaversorgung. Unfallchirurgie 25, 100–107 (1999). https://doi.org/10.1007/BF00578717

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