挥发性麻醉剂可提高盲肠结扎和穿刺后的存活率。
Volatile anesthetics improve survival after cecal ligation and puncture.
机构信息
* Research Associate, Institute of Anesthesiology, University Hospital Zurich and Institute of Physiology and Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland. † Research Assistant, Department of Anesthesiology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, and Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois. ‡ Full Professor, Department of Anesthesiology, University of Illinois College of Medicine at Chicago. § Technician, Institute of Anesthesiology, University Hospital Zurich and Institute of Physiology and Zurich Centre for Integrative Human Physiology, University of Zurich. ‖Research Associate, Institute of Anesthesiology, University Hospital Zurich and Institute of Physiology and Zurich Centre for Integrative Human Physiology, University of Zurich. # Associate Professor, Department of Anesthesiology, University of Illinois College of Medicine at Chicago, and Department of Pharmacology, University of Illinois at Chicago. ** Associate Professor, Department of Anesthesiology, University of Illinois College of Medicine at Chicago, and Department of Pharmacology, University of Illinois at Chicago. †† Full Professor, Institute of Anesthesiology, University Hospital Zurich and Institute of Physiology and Zurich Centre for Integrative Human Physiology, University of Zurich.
出版信息
Anesthesiology. 2013 Oct;119(4):901-6. doi: 10.1097/ALN.0b013e3182a2a38c.
BACKGROUND
Sepsis remains a leading cause of death in intensive care units. There is growing evidence that volatile anesthetics have beneficial immunomodulatory effects on complex inflammation-mediated conditions. The authors investigated the effect of volatile anesthetics on the overall survival of mice in a sepsis model of cecal ligation and puncture (CLP).
METHODS
Mice (N = 12 per treatment group) were exposed to anesthetic concentrations of desflurane, isoflurane, and sevoflurane either during induction of sepsis or when the mice showed pronounced symptoms of inflammation. Overall survival, as well as organ function and inflammation was compared with the CLP group without intervention.
RESULTS
With desflurane and sevoflurane conditioning (1.2 minimal alveolar concentration for 2 h immediately after induction of CLP) overall survival was improved to 58% and 83%, respectively, compared with 17% in the untreated CLP group. Isoflurane did not significantly affect outcome. Application of sevoflurane 24 h after sepsis induction significantly improved overall survival to 66%.
CONCLUSIONS
Administration of the volatile anesthetics desflurane and sevoflurane reduced CLP-induced mortality. Anesthesia may be a critical confounder when comparing study data where different anesthesia protocols were used.
背景
脓毒症仍然是重症监护病房死亡的主要原因。越来越多的证据表明，挥发性麻醉剂对复杂的炎症介导的疾病具有有益的免疫调节作用。作者研究了挥发性麻醉剂对盲肠结扎和穿刺（CLP）脓毒症模型中小鼠总生存率的影响。
方法
每组 12 只小鼠暴露于地氟烷、异氟烷和七氟烷的麻醉浓度，无论是在脓毒症诱导期间还是在小鼠表现出明显炎症症状时。将总生存率以及器官功能和炎症与未干预的 CLP 组进行比较。
结果
用地氟烷和七氟烷预处理（CLP 诱导后立即以 1.2 最小肺泡浓度持续 2 小时），与未治疗的 CLP 组的 17%相比，总生存率分别提高到 58%和 83%。异氟烷对结果无显著影响。在脓毒症诱导后 24 小时应用七氟烷可显著提高总生存率至 66%。
结论
给予挥发性麻醉剂地氟烷和七氟烷可降低 CLP 诱导的死亡率。在比较使用不同麻醉方案的研究数据时，麻醉可能是一个关键的混杂因素。
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