丙泊酚长期镇静对重型脓毒症患者免疫平衡的影响

Effects of long time sedation with propofol on immune balance in severe sepsis

目的观察丙泊酚长期镇静对腹内感染所致重型脓毒症患者促炎/抗炎性细胞因子平衡的影响。方法15例符合重型脓毒症诊断的外科腹腔感染患者术后随机分为丙泊酚镇静组和对照组,另设健康组3例。丙泊酚组为连续使用丙泊酚镇静超过48h,对照组未常规应用镇静药物。比较两组患者入SICU即刻和48h后血清TNF-α、IL-10、TNF-α/IL-10(T/I)比值。结果两组患者入SICU后即刻细胞因子明显高于健康组,组间无差别。丙泊酚平均负荷量0．063 mg/kg,维持剂量0．054 mg/(kg·h)。48 h后丙泊酚组TNF-α、IL-10较入院明显下降,T/I比值较基础值有增高趋势(P=0．057)。对照组TNF-α、IL-10均较入院时差异无显著性,丙泊酚组IL-10低于对照组,而T/I比值高于对照。结论重型脓毒症患者使用丙泊酚长期镇静可抑制促炎因子TNF-α、抗炎因子IL-10的分泌,但使免疫平衡向Th1方向漂移,外科高危患者术后应用镇静药物应考虑其对免疫平衡的影响。

Objective To clarify the effects of sedation with propofol on pro/anti-inflammatory cytokines balance in severe sepsis patients resulted from intra-αbdominal infection. Methods Fifteen patients with severe sepsis were randomly divided into two groups, propofol group received intravenous propofol sedation more than 48 hours, and no sedation drug were used in control group, 3 volunteers as healthy group. Plasma TNF-α, IL-10 concentrations were measured at admission and 48 hours later, the ratio of TNF-α/IL-10 （T/I） were also calculated. Results Levels of both TNF-α, IL- 10 were significantly elevated in patients compared with healthy group, but no difference between propofol and control group. The mean load doses of propofol was 0.063 mg/kg and maintained at 0.054 mg/（kg·h）. After 48 hours infusion of propofol, TNF-α, IL-10 decreased significantly compared with admission in propofol group, while no changed in control group. Compared with control group, IL-10 was lower and ratio of T/I was higher in propofol group. Conclusion Sedation with propofol in severe sepsis patients attenuated the pro-and anti-inflammatory cytokine responses. Moreover, propofol accelerate the shift to Thl. These findings suggest that the influence of sedation drug on immune function must be considered in sepsis patients.