氯胺酮对心脏瓣膜置换术患者血浆粘附分子及心肌损伤的影响  

Effect of ketamine on plasma adhesion molecules and myocardial injury in patients undergoing cardiac valve replacement

作　　者：冯华[1] 徐军美 谭嵘[1] 常业恬[1] 

机构地区：[1]中南大学湘雅二医院麻醉科

出　　处：《中华麻醉学杂志》2004年第11期820-822,共3页Chinese Journal of Anesthesiology

摘　　要：目的 探讨静脉注射氯胺酮对心脏瓣膜置换术患者血浆粘附分子及心肌损伤的影响。方法 20例择期行心脏瓣膜置换术的患者,随机分为氯胺酮组(K组)和对照组(C组),每组10例。K组于麻醉诱导和转流开始时静脉注射氯胺酮 2mg·kg-1,C组则给予等容量生理盐水。分别于麻醉诱导前(T0)、体外循环(CPB)开始后20 min(T1)、升主动脉开放后30 min(T2)、停机后4 h(T3)和24 h(T4)抽取动脉血,测定血浆颗粒蛋白-140(P-selectin)、白细胞粘附分子-1(L-selectin)、细胞间粘附分子-1(ICAM-1)、白细胞介素-6(IL-6)和心肌肌钙蛋白I(cTnI)的浓度。结果 与T0比较,T1-4时两组血浆ICAM-1、P-selectin、L-selectin和IL-6浓度均升高(P<0.01),T2-4时cTnI的浓度升高(P<0.01);与C组比较,K组T2-4时血浆P-selectin、L-selectin、cTnI浓度降低,T1-4时ICAM-1、IL-6浓度降低(P<0.05或0.01)。结论 氯胺酮能降低CPB期间患者血浆粘附分子和IL-6的水平,减轻CPB引起的炎症反应,对缺血再灌注心肌具有保护作用。Objective It has been shown that ketamine can effectively suppress expression of cell adhesion molecules in vitro. The purpose of this study was to investigate the effect of ketamine on plasma adhesion molecules in vivo during cardiac valve replacement.Methods Twenty ASA Ⅲ-Ⅳ patients (7 males, 13 females) aged 23-65 yrs, weighing 31-77 kg undergoing cardiac valve replacement were randomly divided into two groups of 10 patients each : ketamine group received ketamine 2 mg·kg-1 i.v. before induction of anesthesia and at the start of CPB and control group received normal saline instead of ketamine. Blood samples were taken from radial artery for determination of plasma P-selectin, L-selectin, ICAM-1, IL-6 and cTnI concentrations before induction of anesthesia (T0 ,baseline) , 20 min after initiation of CPB (T1) , 30 min after aortic declamping (T2) 4 h and 24 h after CPB (T3, T4) . Results There was no significant difference between the two groups in age, weight, operation time, CPB time and aortic cross-clamping time. The concentrations of P-selectin, L-selectin, ICAM-1 and IL-6 at T1-4 and cTnI at T2-4 increased significantly compared to baseline (T0) in both groups ( P < 0.01). The concentrations of P-selectin, L-selectin, cTnl at T2-4 and ICAM-1, IL-6 at T1-4 were significantly lower in ketamine than in control group (P < 0.05.) .Conclusion Ketamine can protect myocardium during cardiac valve replacement performed with CPB by inhibiting plasma P-selectin, L-selectin, ICAM-1 and IL-6.

关 键 词：血浆 氯胺酮 患者 粘附分子 心脏瓣膜置换术 P-SELECTIN L-SELECTIN 结论 水平 开放 

分 类 号：R614[医药卫生—麻醉学]