酒精滥用与围手术期免疫功能障碍  

作　　者：Alexandra Lau, MD Vera von Dossow, MD Michael Sander, MD Martin MacGuill, MD Nadine Lanzke, DVW Claudia Spies, MD 王海涛(译) 李士通(校) 

机构地区：[1]Department Of Anesthesiology and Intensive Care Medicine Unit, Campus Virchow-Klinikum and Campus Charite Mitte, CharitY-University Hospital Berlin, Berlin, Germany [2]不详

出　　处：《麻醉与镇痛》2011年第2期86-90,共5页Anesthesia & Analgesia

摘　　要：长期酗酒患者的麻醉不良后果包括：手术后感染风险增加3～5倍，重症监护室停留时间和住院时间延长。手术后高感染率的原因归结为长期酗酒患者免疫反应的改变。手术前，长期酗酒患者T辅助淋巴细胞1/T辅助淋巴细胞2（Th1/Th2）降低，手术后仍然减低。围手术期低Th1／Th2是迟发感染的预兆。长期酗酒患者手术后的细胞毒性淋巴细胞（Tc1／Tc2）也减低，并且减低状态会持续5天。手术后，长期酗酒患者全血的白介素（IL）-6／IL-10比值以及脂多糖（LPS）激发的γ干扰素（INF-γ）／IL-10比值也是减低的。Th1／Ih2、Tc1/Tc2以及脂多糖激发INF-γ／IL-10比值的降低是手术后迟发感染的预兆。因此，围手术期干预的目的在于尽力减轻免疫系统的调控异常。The anesthesiological sequelae of long-term alcohol abuse include a three to fivefold increased risk of postoperative infection, prolonged intensive care unit stays and longer hospital stays. The cause of the higher infection rates is an altered immune response in long-term alcoholic patients. Preoperatively, the T helper cells 1 to T helper cells 2 ratio is depressed in long-term alcoholic patients and remains suppressed after surgery. The lower preoperative T helper cells 1 to T helper cells 2 ratio is prediaive of later onset of infections. Postoperatively, the cytotoxic lymphocyte （Tc1/Fc2） ratio is decreased in long-term alcoholic patients and remains depressed for 5 days. The interleukin （IL）-6/IL-10 ratio and the lipopolysaccharide-stimulated interferon γ/IL-10 ratio in whole blood cells are decreased after surgery in long-term alcoholic patients. Depressed Tc1/Tc2, IL-6/ IL-10 and lipopolysaccharide-stimulated interferon γ/IL-10 ratios in the postoperative period are predictive of subsequent postoperative infections. Perioperative interventions should aim to minimize dysregulation of the immune system.

关 键 词：围手术期 免疫功能障碍 酒精滥用 T辅助淋巴细胞1 TH1/TH2 细胞毒性淋巴细胞 IL-10 TC1/TC2 

分 类 号：R641.03[医药卫生—外科学]