Perioperative fluctuation in plasma levels of granulocyte elastase and alpha-1-antitrypsin: the influence of the severity of surgical intervention and their effect on the respiratory index.

In order to examine whether granulocyte elastase is related to surgical stress and postoperative respiratory function, the perioperative plasma levels of granulocyte elastase and alpha 1-antitrypsin were periodically measured in 49 patients who underwent various operations and the correlation between these levels and the respiratory index was examined. A strong correlation between elevated plasma levels of granulocyte elastase and the degree of aggressiveness of surgery was quite conspicuous; as the operative intervention became more severe, the plasma levels of granulocyte elastase were higher. The plasma level of alpha 1-antitrypsin was in inverted relation to granulocyte elastase. Moreover, marked and prolonged elevation of plasma granulocyte elastase levels induced postoperative pulmonary complications. A highly significant positive correlation was found between the plasma level of granulocyte elastase and the respiratory index. Elevated granulocyte elastase and/or decreased alpha 1-antitrypsin may therefore be implicated in the etiology of postoperative respiratory dysfunction. Thus, an abnormal elevation of plasma granulocyte elastase may allude the existence of postoperative respiratory dysfunction.