Huettemann Egbert, Jung Annabell, Vogelsang Heinz, Hout Nicole van, Sakka Samir G
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University, Erlanger Allee 101, D-07747 Jena, Germany.
J Anesth. 2006;20(2):86-91. doi: 10.1007/s00540-005-0377-2.
Patients with severe brain injury often require long-term sedation and have a high incidence of nosocomial infections, causing an increased mortality rate. However, whether anesthetic drugs might contribute to immunosuppressive effects remains unclear.
In this prospective study, we investigated the effects of propofol (4-6 mg x kg(-1) x h(-1)) and methohexital (1-3 mg x kg(-1) x h(-1)) on neutrophil leukocyte function and immune status in 21 patients with brain injury who either received propofol (n = 12; 9 male, 3 female; mean age, 51 +/- 15 years) or methohexital (n = 9; 8 male, 1 female; mean age, 48 +/- 17 years) after admission to the intensive care unit (ICU). Both sedatives were administered over 7 days and individual dosage was adapted according to clinical requirements. Neutrophil leukocyte function was assessed as phagocytosis and respiratory oxidative burst activity. Furthermore, leukocyte subpopulations, and surface markers of lymphocytes and monocytes (CD3; CD4; CD45RO; CD4/CD45RO; CD25; CD4 and CD25; CD54; CD69; CD14/HLA-DR; CD8; CD3/HLA-DR; CD4 : CD8 ratio) were assessed. Blood samples were drawn on ICU admission, and on days 3, 7, and 14. Patients' demographics were compared by Wilcoxon test and laboratory results were compared by analysis of variance (ANOVA) for repeated measurements, with an all pairwise multiple comparison procedure.
There were no significant differences in neutrophil oxidative burst and phagocytosis within or between the two groups at the different time points. With respect to cellular markers of lymphocytes and monocytes, all values throughout remained in the normal range.
Methohexital and propofol exhibited no significant effects on neutrophil function and immune status in patients with severe brain injury requiring long-term sedation.
重型脑损伤患者常需要长期镇静，且医院感染发生率高，导致死亡率增加。然而，麻醉药物是否会产生免疫抑制作用仍不清楚。
在这项前瞻性研究中，我们调查了丙泊酚（4 - 6毫克·千克⁻¹·小时⁻¹）和甲己炔巴比妥（1 - 3毫克·千克⁻¹·小时⁻¹）对21例脑损伤患者中性粒细胞功能和免疫状态的影响。这些患者在入住重症监护病房（ICU）后，分别接受丙泊酚（n = 12；9例男性，3例女性；平均年龄，51 ± 15岁）或甲己炔巴比妥（n = 9；8例男性，1例女性；平均年龄，48 ± 17岁）治疗。两种镇静剂均给药7天，并根据临床需求调整个体剂量。中性粒细胞功能通过吞噬作用和呼吸氧化爆发活性进行评估。此外，还评估了白细胞亚群以及淋巴细胞和单核细胞的表面标志物（CD3；CD4；CD45RO；CD4/CD45RO；CD25；CD4和CD25；CD54；CD69；CD14/HLA - DR；CD8；CD3/HLA - DR；CD4:CD8比值）。在入住ICU时、第3天、第7天和第14天采集血样。患者人口统计学数据采用Wilcoxon检验进行比较，实验室结果采用重复测量方差分析（ANOVA）进行比较，并进行所有两两多重比较程序。
在不同时间点，两组内或两组间中性粒细胞氧化爆发和吞噬作用均无显著差异。关于淋巴细胞和单核细胞的细胞标志物，所有值始终保持在正常范围内。
对于需要长期镇静的重型脑损伤患者，甲己炔巴比妥和丙泊酚对中性粒细胞功能和免疫状态无显著影响。
