Sander Michael, von Heymann Christian, Neumann Tim, Braun Jan P, Kastrup Marc, Beholz Sven, Konertz Wolfgang, Spies Claudia D
Department of Anesthesiology, University Hospital Charité, Campus Charité Mitte, Charité-University Medicine, Berlin, Germany.
Alcohol Clin Exp Res. 2005 Sep;29(9):1677-84. doi: 10.1097/01.alc.0000179365.58403.b2.
Previous studies have shown that 20% of all patients admitted to the hospital abuse alcohol and have increased morbidity after surgery. Long-term alcoholic patients are shown to suffer from immune alterations, which might be critical for adequate postoperative performance. Cardiac surgery with cardiopulmonary bypass (CPB) also leads to pronounced immune alteration, which might be linked with patients' ability to combat infections. Therefore, the aim of our study was to investigate the perioperative levels of TNF-alpha, interleukin-6, interleukin-10, and cortisol in long-term alcoholic and nonalcoholic patients undergoing cardiac surgery to elucidate a possible association with postoperative infections.
Forty-four patients undergoing elective cardiac surgery were included in this prospective study. Long-term alcoholic patients (n=10) were defined as having a daily ethanol consumption of at least 60 g and fulfilling the Diagnostic and Statistical Manual of Mental Disorders for alcohol abuse. The nonalcoholic patients (n=34) were defined as drinking less than 20 g ethanol per day. Blood samples were obtained to analyze the immune status upon admission to hospital, the morning before surgery and on admission to the ICU, the morning of days one and three after surgery.
Basic characteristics of patients did not differ between groups. Long-term alcoholics had a fourfold increase in postsurgery infection rate and prolonged need for ICU treatment and mechanical ventilation. Postoperative levels of interleukin-10 and cortisol were significantly increased in long-term alcoholic patients compared with nonalcoholic patients. These observations were in line with postoperative interleukin-10 being predictive for postoperative infectious complications.
The increased infection rate in long-term alcoholics strengthens the urgent need for interventional approaches providing modulation of the perioperative immune and HPA response in these high-risk patients to counteract their postoperative immune suppression.
先前的研究表明，所有入院患者中有20%酗酒，术后发病率增加。长期酗酒患者存在免疫改变，这可能对术后的充分恢复至关重要。体外循环心脏手术也会导致明显的免疫改变，这可能与患者抵抗感染的能力有关。因此，我们研究的目的是调查接受心脏手术的长期酗酒患者和非酗酒患者围手术期肿瘤坏死因子-α、白细胞介素-6、白细胞介素-10和皮质醇的水平，以阐明与术后感染的可能关联。
本前瞻性研究纳入了44例接受择期心脏手术患者。长期酗酒患者（n = 10）定义为每日乙醇摄入量至少60克且符合酒精滥用的《精神疾病诊断与统计手册》标准。非酗酒患者（n = 34）定义为每日乙醇摄入量少于20克。在入院时、手术前一天上午、入住重症监护病房时、术后第一天和第三天上午采集血样以分析免疫状态。
两组患者的基本特征无差异。长期酗酒患者术后感染率增加四倍，重症监护病房治疗和机械通气需求延长。与非酗酒患者相比，长期酗酒患者术后白细胞介素-10和皮质醇水平显著升高。这些观察结果与术后白细胞介素-10可预测术后感染并发症一致。
长期酗酒患者感染率增加，强化了迫切需要采取干预措施来调节这些高危患者围手术期免疫和下丘脑-垂体-肾上腺轴反应，以抵消其术后免疫抑制的需求。
