Kotani N, Hashimoto H, Sessler D I, Kikuchi A, Suzuki A, Takahashi S, Muraoka M, Matsuki A
Department of Anesthesiology, University of Hirosaki, Japan.
Anesthesiology. 1998 Nov;89(5):1125-32. doi: 10.1097/00000542-199811000-00012.
Alveolar macrophages are a critical part of the defense against pulmonary infection. Thus the authors determined time-dependent changes in alveolar macrophage functions in patients having surgery who were anesthetized with isoflurane or propofol.
Patients anesthetized with propofol (n = 30) or isoflurane (n = 30) during orthopedic surgery were studied. Alveolar macrophages were harvested by bronchoalveolar lavage immediately, and 2, 4, and 6 h after induction anesthesia and at the end of surgery. The fraction of aggregated and nonviable macrophages was determined. Then phagocytosis was measured by ingestion of opsonized and unopsonized particles. Finally, microbicidal activity was determined as the ability of the macrophages to kill Listeria monocytogenes directly.
Demographic and morphometric characteristics of the patients given propofol and isoflurane were similar, as were their levels of pulmonary function and hemodynamic responses. The fraction of alveolar macrophages ingesting opsonized and unopsonized particles, and the number of particles ingested, decreased significantly over time, with the decrease slightly but significantly greater during isoflurane anesthesia. Microbicidal function decreased progressively during anesthesia and surgery, with the decrease almost twice as great during isoflurane compared with propofol anesthesia. The fraction of aggregated macrophages and recovered neutrophils increased over time in the patients given each anesthetic.
Pulmonary immunologic function changed progressively during anesthesia and surgery. The data from this study suggest that pulmonary defenses are modulated by the type of anesthesia and by the duration of anesthesia and surgery.
肺泡巨噬细胞是抵御肺部感染的关键部分。因此，作者确定了接受异氟烷或丙泊酚麻醉的手术患者肺泡巨噬细胞功能随时间的变化。
对骨科手术中接受丙泊酚（n = 30）或异氟烷（n = 30）麻醉的患者进行研究。在诱导麻醉后即刻、2、4和6小时以及手术结束时，通过支气管肺泡灌洗收集肺泡巨噬细胞。测定聚集和无活力巨噬细胞的比例。然后通过吞噬调理素化和未调理素化颗粒来测量吞噬作用。最后，将巨噬细胞直接杀死单核细胞增生李斯特菌的能力确定为杀菌活性。
接受丙泊酚和异氟烷的患者的人口统计学和形态学特征相似，其肺功能和血流动力学反应水平也相似。随着时间的推移，摄取调理素化和未调理素化颗粒的肺泡巨噬细胞比例以及摄取的颗粒数量显著下降，在异氟烷麻醉期间下降幅度略大但显著更大。在麻醉和手术期间杀菌功能逐渐下降，与丙泊酚麻醉相比，异氟烷麻醉期间下降幅度几乎大一倍。接受每种麻醉的患者中，聚集巨噬细胞和回收中性粒细胞的比例随时间增加。
在麻醉和手术期间，肺免疫功能逐渐改变。本研究数据表明，肺防御受到麻醉类型以及麻醉和手术持续时间的调节。
