ICU镇静的利弊把控PPT.ppt

对固有免疫和获得性免疫的影响 Table1 Summarized effects of sedatives on the innate and adaptive immune response (↓represents immunodepression; ↑represents immune potentiation; - unknown effect) Drug Class InnateImmune Response Adaptive Immune Response Propofol ↓ - Benzodiazepines ↓ - Opioids ↓ ↓ α2-Adrenoceptor agonists↑ - Robert D. et al, Anesthsiology Clin 29 (2011) 不同的药物对免疫系统不同的影响 Immunomodulatory effects of sedative agents used in ICU patients Sedative agent Main results Opioids Suppression of mitogen-stimulated proliferation of T and B-lymphocytes Suppression of natural killer, and primary antibody production Inhibition of phagocytosis by macrophages Suppression of IL-2,IL-6,INFg,and NO production Activation of sympathic nervous system, and the hypothalamic-pituitary-adrenal axis Enhancement of Pseudomonas aeruginosa virulence Reduction of bacterial clearance via impairment of TLR-9-NF-B signaling Enhancement of cellular apoptosis Benzodiazepines Inhibition of IL-1,IL-6,and TNF-a production Supression of macrophage migration and phagocytosis Clonidine and dexmetctomdine Reducton of IL-1b, and IL-6 production Sympatholytic effects Propofol Suppression of H2O2, NO, and O production; improvement of endothelial dysfunction Supression of TNF-a,IL-b,IL-10 Attenuation of leukosequestration, pulmonary edema, and pulmonary