脊柱外科手术患者使用糖皮质激素对术后外周血白细胞的影响

Effect of Glucocorticoid Administration on Postoperative Peripheral Leukocytes in Patients with Spinal Surgery

关键词:  糖皮质激素  外周白细胞  中性粒细胞

Key words:  glucocorticoid  peripheral leukocytes  neutrophils

摘要:

目的 研究脊柱外科手术患者使用糖皮质激素对外周血白细胞的影响。方法 回顾性分析丽水市中心医院2015年1月-2018年6月脊柱外科手术患者共986例，根据有无使用糖皮质激素情况将患者分成：激素组（n=398）和无激素组（n=588），通过统计患者基础信息、外周血白细胞计数，比较2组术前、术后0~2 d、术后3~6 d和术后7~10 d的白细胞总数、中性粒细胞、淋巴细胞、单核细胞、嗜酸性粒细胞和嗜碱性粒细胞计数的变化情况。结果 与术前相比，激素组术后白细胞、中性粒细胞一度性升高，术后0~2 d时最高，术后7~10 d计数水平虽略下降，但仍极显著高于无激素组（P<0.01），分别达（8.66±2.12）×10⁹·L^-1与（6.03±0.64）×10⁹·L^-1；淋巴细胞与嗜酸性粒细胞呈现先降低后升高的趋势，治疗结束后相比术前均存在显著性或极显著性差异（P<0.05或P<0.01）；糖皮质激素用量在40~440 mg内与白细胞水平升高率呈正相关。结论 糖皮质激素使用可升高脊柱外科手术患者术后外周血白细胞计数。

Abstract:

OBJECTIVE To study the effect of glucocorticoid administration on postoperative peripheral leukocytes in spinal surgery patients. METHODS A retrospective analysis was conducted on 986 patients of spinal surgery in the Lishui Central Hospital from January 2015 to June 2018. The patients were divided into hormone group(n=398) and hormone-free group(n=588) according to glucocorticoid administration. The changes in the total number of leukocyte, neutrophil, lymphocyte, monocyte, eosinophil, and basophil count between the two groups before surgery, 0-2 d after surgery, 3-6 d after surgery and 7-10 d after surgery were compared by counting the patients' basic information, peripheral blood leukocyte count. RESULTS Compared with preoperative level, the leukocyte and neutrophil count increased in the hormone group, and were the highest at 0-2 d after surgery, and the count at 7-10 d after surgery were lower but still significantly higher than that of the hormone-free group(P<0.01), reaching (8.66±2.12)×10⁹·L^-1 and (6.03±0.64)×10⁹·L^-1 respectively. Lymphocyte and eosinophil count showed a trend of decreasing first and then increasing. There was a significant or extremely significant difference tendency after treatment compared with that before surgery(P<0.05 or P<0.01). Glucocorticoid dosage in the range of 40-440 mg was positively correlated with the increase of leukocyte level. CONCLUSION Glucocorticoid administration can increase the peripheral blood leukocyte count after spinal surgery.