Effect of propofol on stress response and immune balance in patients with severe trauma hemorrhage after fluid resuscitation

Abstract

Objective To explore the stress response and immune balance in patients with severe trauma hemorrhage after fluid resuscitation and to clarify the clinical effect of Propofol administered with continuous intravenous infusion pump on it.Methods With prospective,randomized and control analysis,54 patients treated with fluid resuscitation following severe trauma hemorrhage admitted from October 1st,2008 to December 1st,2009 were studied.Another 20 healthy volunteers were enrolled as control group (C group). Patients were randomly divided into:conventional treatment group (R group,n =27 ) and conventional therapy combined with propofol treatment ( P group,n =27) as per gender,age,ISS score,estimated blood loss four factors and the principle of minimum distribution imbalance index.HR,MAP,the levels of stress hormones [ norepinephrine (NE),cortisol (Cor) ],immune function ( T lymphocyte subsets Th1/Th2) and other biomarkers were observed.Mortality within 28 d between R group and P group was compared.ANOVA was used for the comparison of biomarkers,and independent samples t test was employed to compare variables between the two groups. Results Plasma cortisol (Cor),norepinephrine (NE),alanine aminotransferase (ALT),creatinine ( Cr),blood glucose,and Th1 and Th2 lymphocytes in patients were significantly higher than those in healthy volunteers of group C (P ＜0.01 ),and Th1/Th2 was significantly lower than those in healthy volunteers of C group (P =0.001 ).The ALT (48 h),Glu (6 h),NE (24 h and 48 h) and Cor (6 h and 24 h) of patients in P group were lower than those in R group ( P ＜0.05 ),and Th1 and Th2 were lower than those in R group at different intervals ( Th1:24h P =0.028,48 hP=0.002 ; Th2:6 h P=0.033,24 h P=0.007,48 h P=0.009),and Th1/Th2 ratio (48 h) was significantly higher in P group than that in R group (P =0.028),but there was no significant difference in mortality within 28d between the two groups. Conclusions Strong stress response,immune suppression and organ dysfunction can occur in the early stages of severe trauma hemorrhage after fluid resuscitation.Propofol can inhibit excessive stress response,modulate the immune balance and protect the important organs in those exsanguination patients from severe trauma. Key words: Trauma hemorrhage; Fluid resuscitation; Propofol; Stress response; Immune balance; T lymphocyte subsets; Norepinephrine; Cortisol