论文部分内容阅读
目的观察丙泊酚长期镇静对腹内感染所致重型脓毒症患者促炎/抗炎性细胞因子平衡的影响。方法15例符合重型脓毒症诊断的外科腹腔感染患者术后随机分为丙泊酚镇静组和对照组,另设健康组3例。丙泊酚组为连续使用丙泊酚镇静超过48h,对照组未常规应用镇静药物。比较两组患者入SICU即刻和48h后血清TNF-α、IL-10、TNF-α/IL-10(T/I)比值。结果两组患者入SICU后即刻细胞因子明显高于健康组,组间无差别。丙泊酚平均负荷量0．063 mg/kg,维持剂量0．054 mg/(kg·h)。48 h后丙泊酚组TNF-α、IL-10较入院明显下降,T/I比值较基础值有增高趋势(P=0．057)。对照组TNF-α、IL-10均较入院时差异无显著性,丙泊酚组IL-10低于对照组,而T/I比值高于对照。结论重型脓毒症患者使用丙泊酚长期镇静可抑制促炎因子TNF-α、抗炎因子IL-10的分泌,但使免疫平衡向Th1方向漂移,外科高危患者术后应用镇静药物应考虑其对免疫平衡的影响。
Objective To investigate the effects of long-term sedation of propofol on the pro-inflammatory / anti-inflammatory cytokine balance in patients with severe sepsis induced by intra-abdominal infection. Methods Fifteen patients with surgical abdominal infection diagnosed with severe sepsis were randomly divided into propofol sedation group and control group, and another three healthy individuals. Propofol group for continuous use of propofol sedation more than 48h, the control group is not routinely used sedatives. The serum levels of TNF-α, IL-10 and TNF-α / IL-10 (T / I) in both SICU and 48h groups were compared. Results The two groups of patients immediately after SICU cytokines were significantly higher than the healthy group, no difference between groups. The average loading of propofol was 0.063 mg / kg and the maintenance dose was 0.054 mg / (kg · h). After 48 h, the levels of TNF-α and IL-10 in propofol group were significantly lower than those in admission group, and the T / I ratio was higher than the baseline value (P = 0.057). The levels of TNF-α and IL-10 in the control group were not significantly different from those on admission. The levels of IL-10 in the propofol group were lower than those in the control group, while the T / I ratio was higher than that in the control group. Conclusion Long-term sedation of patients with severe sepsis can inhibit the secretion of pro-inflammatory cytokine TNF-α and anti-inflammatory cytokine IL-10, but shift the immune balance towards Th1. Septic drugs should be considered after surgery in high-risk surgical patients Impact on immune balance.