丙泊酚与依托咪酯麻醉对感染性休克患者细胞免疫功能的影响

Effects of propofol and etomidate anesthesia on cellular immune function of septic shock patients

目的研究丙泊酚与依托咪酯对感染性休克围手术期患者免疫功能的影响。方法选择2009年3月-2010年10月在医院临床诊断为感染性休克拟行手术病灶清除的患者78例,按患者接受手术次序进行分组:单号为丙泊酚组,双号为依托咪酯组,各39例;两组分别于麻醉诱导前、术毕及术后1、3、7d分别检测CD3+、CD4+、CD8+的百分率及CD4+/CD8+比值。结果两组患者基线资料具有可比性;与麻醉前相比较,两组患者手术结束时CD3+与CD4+的水平均较麻醉前显著降低(P<0.05),其中,丙泊酚组下降更为显著(P<0.05);术后1d两组患者的CD3+与CD4+的水平均开始回升,术后7d回升到麻醉前水平;两组间比较,术毕及术后1d丙泊酚组CD3+的水平显著低于依托咪酯组(P<0.05);术毕、术后1、3d丙泊酚组CD4+的水平显著低于依托咪酯组(P<0.05);与麻醉前及依托咪酯组相比较,丙泊酚组术毕、术后1、3d患者CD4+/CD8+水平均显著降低(P<0.05),分别为(1.1±0.5)、(1.3±0.9)、(1.4±0.4)%,于术后7d恢复至麻醉前水平。结论感染性休克围手术期使用依托咪酯对患者免疫功能影响较小。

OBJECTIVE To study the influence of propofol or etomidate on cytoimmunity of septic shock patients during periperative period.METHODS A total of 78 patients with septic shock were divided into two groups,39 cases were respectively given propofol or etomidate.The percentage of CD3＋,CD4＋,CD8＋ and CD4＋/CD8＋ before induction of anesthesia,and 1,3 and 7 days albert and after operation were evaluated.RESULTS The baseline data were comparable;as compared with that before the anesthesia,both of the two groups’ CD3＋ and CD4＋ at the end of surgery significantly decreased（P〈0.05）,while the propofol group decreased the most significantly（P〈0.05）;CD3＋ and CD4＋ levels of the two groups began to rise 1 day after the operation,and returned back to the level before the anesthesia 7 days after the operation;the CD3＋ level of the propofol group was significantly lower than that of the etomidate group 1 day albert and after the operation（P〈0.05）;the CD4＋ level of the propofol groups was significantly lower than that of the etomidate group 3 days albert and after the operation（P〈0.05）;as compared with that before the anesthesia and the etomidate group,the CD4＋/CD8＋ of the propofol groups albert,1 day and 3 days after operations were（1.1±0.5）%,（1.3±0.9）% and（1.4±0.4）%,which were significantly decreased and restored to the level before the anesthesia 7 days after the operation.CONCLUSION The application of etomidate during perioperative period has less impact on immune function of the septic shock patients.