Intraoperative modulation of alveolar macrophage function during isoflurane and propofol anesthesia
Intraoperative modulation of alveolar macrophage function during isoflurane and propofol anesthesia
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DOI：
10.1097/00000542-199811000-00012
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发表时间：
1998-11-01
期刊：
影响因子：
8.8
通讯作者：
Matsuki, A
中科院分区：
文献类型：
--
作者：
Kotani, N;Hashimoto, H;Matsuki, A
背景：肺泡巨噬细胞是抵抗肺部感染的重要防御细胞。因此，作者测定了异氟醚或异丙酚麻醉下手术患者肺泡巨噬细胞功能的时间依赖性变化。方法：骨科手术中异丙酚和异氟醚麻醉各30例。分别于麻醉诱导后即刻、麻醉诱导后2、4、6h及手术结束时经支气管肺泡灌洗取肺泡巨噬细胞。测定聚集和死亡巨噬细胞的比例。然后通过摄取调理的和未调理的颗粒来测量吞噬功能。结果：异丙酚和异氟醚的人口学和形态计量学特征相似，他们的肺功能和血流动力学反应水平也相似。随着时间的推移，肺泡巨噬细胞吞噬调理颗粒和未调理颗粒的比例和吞噬颗粒的数量显著减少，异氟醚麻醉期间的减少幅度较小，但明显较大。在麻醉和手术过程中，杀菌功能逐渐下降，异氟醚麻醉期间的下降幅度几乎是异丙酚的两倍。随着麻醉时间的延长，患者体内聚集的巨噬细胞和恢复的中性粒细胞比例逐渐增加。结论：麻醉和手术过程中肺免疫功能呈进行性变化。这项研究的数据表明，肺防御受麻醉类型以及麻醉和手术持续时间的影响。
Background: 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 propofolMethods: 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.Results: 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.Conclusions: 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.