丙泊酚持续小剂量镇静对大面积烧伤患者CD14~+单核细胞HLA-DR表达的影响

目的 探讨大面积烧伤患者CD14+单核细胞HLA-DR抗原的表达规律及丙泊酚持续小剂量镇静对HLA-DR抗原表达的影响.方法 选取2010年3月-2011年11月收治的烧伤而积大于30％ TBSA的严重烧伤患者30例,其中17例给予常规治疗(常规治疗组),13例除常规治疗外还应用丙泊酚持续小剂量镇静治疗(丙泊酚治疗组),分别于镇静治疗前及治疗后第1、3、5、7天抽取外周静脉血,流式细胞仪检测CD14+单核细胞表面HLA-DR抗原表达情况.另取20例健康体检者作为健康对照.结果 大面积烧伤患者入院24h内CD14+单核细胞表面HLA-DR抗原表达率(25.07％±14.83％)显著低于健康对照组(76.45％±7.96％,P＜0.01).常规治疗组治疗后第3、5天CD14+单核细胞表面HLA-DR抗原表达率(分别为27.76％±11.36％、27.11％±14.49％)明显低于丙泊酚治疗组(分别为35.44％±11.55％、37.47％±15.46％),差异有统计学意义(p＜0.05),治疗前及治疗后第1、7天两组比较无统计学差异.结论 丙泊酚可能通过抑制应激激素的过度释放而减轻烧伤患者的过度应激反应,进而改善大面积烧伤患者的免疫功能.

Effect of continuous sedation with low-dose propofol on HLA-DR antigen expression on CD14+ monocytes in extensively burned patients

Objective To investigate HLA-DR antigen expression on CD14+ monocytes in extensively burned patients and the influence of continuous sedation with low-dose propofol on the said expression.Methods A total of 30 patients with total burn surface area(TBSA) of at least 30% admitted from Mar.2010 to Nov.2011 were enrolled into this study.Twenty patients were treated using conventional therapy(conventional therapy group),and 13 patients were treated with continuous sedation using lowdose propofol beside conventional treatment(propofol therapy group).Peripheral blood was collected before and after sedation on days 1,3,5,and 7.Flow cytometry was used to detect the HLA-DR antigen expression on CD14+ monocytes.For comparison,20 healthy individuals were also enrolled into the study.Results HLA-DR antigen expression on the CD14+ monocytes of extensively burned patients(25.07%±14.83%) admitted into the hospital within 24 hours of the injury was obviously lower than that of the control group(76.45%±7.96%,P<0.01).The rates of HLA-DR antigen expression in the conventional therapy group on 3 days to 5 days after treatment(27.76%±11.36%,27.11%±14.49%) were lower than that in the propofol therapy group(35.44%±11.55% and 37.47%±15.46%).The difference was statistically significant(P<0.05).No significant difference was found between the two groups on pre-treatment and post-treatment days 1 and 7.Conclusion Propofol may relieve the excessive stress response among extensively burned patients by restraining the excessive release of the main stress hormone to improve the immune function of extensively burned patients.