摘要
目的 观察外科ICU(SICU)严重腹内感染病人使用咪唑安定镇静48 h 对促炎/抗炎平衡的影响,为SICU镇静药物的选用提供理论依据。方法 28例符合重型脓毒症诊断的外科严重腹内感染病人术后随机分为咪唑安定组和对照组,另设健康组5例,咪唑安定组给予咪唑安定镇静,时间超过48 h,对照组使用生理盐水,检测两组病人入SICU即刻和48 h后血清IFN-γ、TNF-α、IL-10、单核细胞表面人类白细胞抗原-DR(HLA-DR)表达。结果 两组病人入SICU后即刻各细胞因子均明显高于健康组,HLA-DR表达显著低于健康组,组间无差别,咪唑安定平均负荷量0.063 mg/kg,维持剂量0.054 mg·kg-1·h-1。48 h后咪唑安定组TNF-α、IL-10较入院明显下降,IFN-γ变化不显著,单核细胞HLA-DR表达有恢复趋势(P=0.057)。对照组IFN-γ、TNF-α、IL-10、HLA-DR均较入院时无显著差异,组间比较IL-10、HIA-DR差异有显著性。结论 咪唑安定长期镇静不仅可发挥其作用平稳、可控性强、遗忘作用好等药理特点,而且在抑制TNF-α等促炎因子、减轻SIRS损伤的同时,降低抗炎因子IL-10分泌、促进单核细胞HLA-DR表达的细胞免疫功能恢复、改善免疫平衡。在外科高危病人术后恰当应用咪唑安定可能对病人预后产生有利影响。
Objective To investigate the pro - /and - inflammatory balance in severe intra - abdominal infective surgical patients who received long - term sedation of midazolam for more than 48 hours. Methods 28 severe sepsis patients resulted from severe intra - abdominal infection were randomly divided into two groups: midazolam group and control group, 5 healthy adults as healthy group. Midazolam group received intravenous midazolam sedation for more than 2 days,and control group received NS. Blood samples were drawn for measurement of interferon-γ(IFN-γ) ,tumor necrosis factor- α(TNF-α), interleukin-10(IL- 10)and HLA - DR expression in monocyte prior to the start and after 48 h of midazolam infusion. Results All the cytokines in two groups were higher than healthy group, and HLA - DR were lower than healthy group,no significant difference were found between groups. Midazolam group received a loading dose of 0.063 mg/kg followed by continuous infusion at 0. 054 mg/kg-1·h-1. After 48 h, midazolam caused significant decreases in TNF - α and IL - 10 level, while no significant change in IFN - 7 and HLA - DR compared with the pre - infusion level. There was no significant change in all the cytokines and HLA - DR in non - sendative treated control group after 48 h. Between two groups, the difference in IL - 10 and HLA - DR were significant. Conclusion The pharmacokinetic properties of midazolam allowed smooth and easy controllable sedation with profound amnesia. Midazolam suppressed the production of pro - and anti - inflammatory cytokines at the same time, prevent further injury in the SIRS and also promote the HLA - DR expression and cellular immuno - function. Choosing a sedative agent such as midazolam may have clinical impliocation in high risk SICU patients.
出处
《中国急救医学》
CAS
CSCD
北大核心
2004年第11期819-820,共2页
Chinese Journal of Critical Care Medicine
