静脉麻醉剂对人血体外细菌清除的影响。

Effects of intravenous anesthetics on bacterial elimination in human blood in vitro.

作者信息

Heller A, Heller S, Blecken S, Urbaschek R, Koch T

机构信息

Department of Anesthesiology and Operative Intensive Care Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Germany.

出版信息

Acta Anaesthesiol Scand. 1998 May;42(5):518-26. doi: 10.1111/j.1399-6576.1998.tb05160.x.

DOI:10.1111/j.1399-6576.1998.tb05160.x

PMID:9605366

Abstract

BACKGROUND

Since anesthetics are widely used in critically ill patients, this study investigates anesthetic effects on neutrophil and monocyte function concerning bacterial elimination in human whole blood.

METHODS

The effects of thiopental (20 and 200 microg/ml), propofol (5 and 50 microg/ml), midazolam (0.15 and 1.5 microg/ml) and ketamine (3 and 30 microg/ml) on elimination of Escherichia (E.) coli from whole blood were investigated in vitro after incubation for 1 h in both clinical (1) (n=10) and 10-fold higher (h) (n=11) concentrations. These data were compared to neutrophil and monocyte phagocytosis (1; n=6) and burst activity (1; n=10, h; n=11), measured by flow cytometry. To enable quantification of the clearance process, a defined number of 10(5) colony forming units of E. coli were added to the blood assays and bacterial growth was determined.

RESULTS

All anesthetics delayed bacterial clearance from the blood in the 10-fold concentration (P<0.05). Thiopental (1+h) and propofol (h) suppressed neutrophil (59+/-3% and 38+/-6%) and monocytic (45+/-6% and 30+/-11%) oxidative burst (P<0.01). Phagocytosis was reduced even after propofol (1) in polymorphonuclear leukocytes (PMN) (34+/-9%; P<0.05) and monocytes (35+/-11%). Ketamine (h) prolonged bacterial elimination (P<0.01), which did correlate with inhibition of monocytic phagocytosis, by 26+/-14%. Midazolam application (h) resulted in an inhibition of PMN-respiratory burst by 19+/-6% (P<0.05) and impaired bacterial clearance (P<0.05).

CONCLUSION

Thiopental, propofol, midazolam and ketamine affect E. coli clearance and neutrophil and monocyte oxidative burst and phagocytosis in vitro only in high concentrations, while thiopental inhibited monocytic burst and propofol impaired PMN phagocytosis even in clinically used concentrations. These data suggest that i.v. anesthetics in concentrations recommended for general anesthesia seem to have minor influence on the investigated host defense mechanisms.

摘要

背景

由于麻醉剂广泛应用于重症患者，本研究调查了麻醉剂对人全血中中性粒细胞和单核细胞功能（涉及细菌清除）的影响。

方法

研究了硫喷妥钠（20和200微克/毫升）、丙泊酚（5和50微克/毫升）、咪达唑仑（0.15和1.5微克/毫升）和氯胺酮（3和30微克/毫升）在临床浓度（1）（n = 10）和10倍高浓度（h）（n = 11）下孵育1小时后对全血中大肠杆菌清除的影响。将这些数据与通过流式细胞术测量的中性粒细胞和单核细胞吞噬作用（1；n = 6）及爆发活性（1；n = 10，h；n = 11）进行比较。为了能够对清除过程进行定量，向血液检测中加入确定数量的10⁵个大肠杆菌菌落形成单位，并测定细菌生长情况。

结果

所有麻醉剂在10倍浓度时均延迟了血液中细菌的清除（P < 0.05）。硫喷妥钠（1 + h）和丙泊酚（h）抑制中性粒细胞（59 ± 3%和38 ± 6%）及单核细胞（45 ± 6%和30 ± 11%）的氧化爆发（P < 0.01）。即使在临床浓度的丙泊酚（1）作用后，多形核白细胞（PMN）（34 ± 9%；P < 0.05）和单核细胞（35 ± 11%）的吞噬作用也降低。氯胺酮（h）延长了细菌清除时间（P < 0.01），这与单核细胞吞噬作用受到26 ± 14%的抑制相关。应用咪达唑仑（h）导致PMN呼吸爆发受到19 ± 6%的抑制（P < 0.05），并损害了细菌清除（P < 0.05）。