Einfluss verschiedener medikamentöser Interventionen auf den perioperativen Verlauf von ACTH, Cortisol und immunreaktiven Beta-Endorphin sowie die postoperative Infektionsrate bei alkoholkranken Patienten

Content Provider	Semantic Scholar
Author	Hegenscheid, Katrin
Copyright Year	2005
Abstract	Postoperative infections are 2to 4-times more frequent in patients with alcohol use disorders with the sequel of prolonged ICU stay. Its association with an altered perioperative hypothalamic-pituitary-adrenal (HPA) axis as response to chronic alcohol consumption and surgical stress is discussed. The aim of this study was to evaluate an intervention with lowdose ethanol, morphine or ketoconazole compared to placebo on the HPA axis and the postoperative infections rate as well as the ICU stay in chronic alcoholic patients. 64 patients with alcohol use disorders undergoing elective surgery of the aerodigestive tract were included in this randomized, double-blind controlled study. Chronic alcoholic patients were defined as having a daily ethanol consumption of at least 60 g and fulfilling the DSM-IV criteria for either alcohol abuse or dependence. Perioperative intervention was started on the evening before surgery and continued for three days after surgery. Blood samples to analyze ACTH, immune reactive beta-endorphine and cortisol were obtained on the morning before intervention and continued on day 1, 3 and 7 after surgery. In the placebo group surgical stress induced a significant increase of ACTH and cortisol. Perioperative intervention with ethanol, morphin or ketoconazol decreased the postoperative ACTH and cortisol increase in these patients. Plasma immune reactive beta-endorphine levels did not differ between groups. Placebo patients had a significantly increased postoperative infections rate whereas any intervention decreased the incidence of infections. Additionally ICU stay was reduced by 9 days in each intervention group compared to placebo. Prophylactic intervention with low dose ethanol, morphine or ketoconazole prevented a postoperative alteration of the HPA axis in chronic alcoholic patients. This was associated with a decreased postoperative infections rate and decreased ICU stay in these patients. alcohol, infection, ACTH, cortisol, beta-endorphine, intervention
File Format	PDF HTM / HTML
Alternate Webpage(s)	http://edoc.hu-berlin.de/dissertationen/hegenscheid-katrin-2004-11-22/PDF/Hegenscheid.pdf
Alternate Webpage(s)	https://doi.org/10.18452/15223
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article