Kress H G, Eberlein T
Institut für Anästhesiologie, Universität Würzburg.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1992 Nov;27(7):393-402. doi: 10.1055/s-2007-1000322.
Study of the references listed leaves no doubt that essential specific and unspecific immune functions are more or less strongly influenced by a wide variety of anaesthetics. In clinically employed concentrations these negative effects are rapidly and completely reversible. No clinically relevant adverse actions on the immune system have ever been identified in short-term anaesthesia with any substance, not even with the thiobarbiturates although these are known to be highly inhibitory. However, matters are entirely different in respect of highly dosed long-term sedation. In such cases, it may occur with e.g. thiobarbiturates or diazepam that in the course of days or weeks concentrations are attained in the tissue which may lead us to expect in vivo quite considerable suppression of both unspecific and antigen-specific cellular immune mechanisms. This expectation, which is first of all based on in-vitro results, has been indirectly supported by a clinical study in patients suffering from craniocerebral trauma who received artificial respiration and in whom an association was seen between thiopental administration and the incidence of bacterial pneumonias. Over and above this, however, the preoperative condition of the patient and of course mainly the operation as such with its associated stress reaction will cause direct and indirect changes in the immune system (Fig. 4). Trauma and anaesthesia exert not only a direct action, but act as inhibitors or stimulators of important immune functions chiefly by modulating the stress response. We are still unaware as to whether and to what extent the prognosis of the individual patient is actually adversely affected by the combined action of these factors. Many findings, however, seem to point to an essential role played by both the surgical trauma and the stress response it induces, as well as by the pre-operative immune status of the patient, in the occurrence of subsequent infectious complications (Fig. 4).
对所列参考文献的研究毫无疑问地表明，各种麻醉剂或多或少会对基本的特异性和非特异性免疫功能产生强烈影响。在临床使用浓度下，这些负面影响可迅速且完全逆转。在任何物质的短期麻醉中，从未发现对免疫系统有临床相关的不良作用，即使是硫代巴比妥酸盐，尽管已知其具有高度抑制作用。然而，高剂量长期镇静的情况则完全不同。在这种情况下，例如使用硫代巴比妥酸盐或地西泮时，在数天或数周内组织中会达到一定浓度，这可能使我们预期在体内非特异性和抗原特异性细胞免疫机制会受到相当大的抑制。这一首先基于体外研究结果的预期，已在一项针对颅脑创伤患者的临床研究中得到间接支持，这些患者接受人工呼吸，研究发现硫喷妥钠的使用与细菌性肺炎的发生率之间存在关联。除此之外，患者的术前状况当然主要是手术本身及其相关的应激反应会导致免疫系统的直接和间接变化（图4）。创伤和麻醉不仅会产生直接作用，而且主要通过调节应激反应来充当重要免疫功能的抑制剂或刺激剂。我们仍然不清楚这些因素的综合作用是否以及在多大程度上会对个体患者的预后产生实际的不利影响。然而，许多研究结果似乎表明，手术创伤及其引发的应激反应以及患者的术前免疫状态在随后感染并发症的发生中起着至关重要的作用（图4）。
