氯胺酮和芬太尼麻醉下胎羊心肺转流应激反应  

The stress responses of fetal lamb under fetal cardiopulmonary bypass with ketamine or fentanyl

作　　者：周成斌[1] 宋兴容[1] 庄建[1] 陈丽英[1] 邱秀香[1] 

机构地区：[1]广东省心血管病研究所心外科,广州市510080

出　　处：《临床麻醉学杂志》2005年第7期477-479,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨氯胺酮和芬太尼对胎羊心肺转流(CPB)应激反应的影响.方法 12头胎羊随机分为氯胺酮组(K组)和芬太尼组(F组).基础麻醉采用氯胺酮10 mg肌肉注射,建立静脉通路后,K组(n=6)氯胺酮3～5 mg·kg-1·h-1静脉维持.F组(n=6)切胸骨前给予芬太尼10～15μg/kg,CPB预充液中加芬太尼50 μg.胎羊CPB 30 min.检测胎羊血糖、乳酸值、血儿茶酚胺和皮质醇含量.结果CPB中两组胎羊血糖含量明显增高(P＜0.05),CPB结束后血糖增高不明显.CPB中K组乳酸值增高显著,F组增高缓慢(P＜0.05);CPB结束后乳酸值持续升高.CPB中K组血儿茶酚胺含量急剧增高(P＜0.01),F组血儿茶酚胺含量变化不明显.CPB中两组血皮质醇含量均明显增高(P＜0.05),组间无显著性差异.CPB结束后胎羊均难以长期存活.结论氯胺酮和芬太尼不能有效抑制胎羊CPB应激反应,过于强烈的应激反应对胎羊存活不利.Objective To study the effects of ketamine or fentanyl on the stress responses of fetal lamb during fetal cardiopulmonary bypass. Methods Twelve fetal lambs were randomly divided into ketamine(K) and fentanyl(F) group. Basic anesthesia was applied with ketamine 10mg intramuscularly in all fetuses. Anesthesia maintenance was carried out with ketamine 3-5mg·kg~(-1)·h~(-1) in group K or with fentanyl 10-15μg/kg intravenously and 50μg priming in group F. Fetal lamb (cardiopulmonary) bypass lasted for 30min. The fetal blood glucose,lactate,catecholamine and cortisol were assayed. Results Blood glucose of two groups increased during bypass(P<0.05), but it (didn't) elevate remarkably after bypass. Blood lactate level of group K increased significantly and that of group F elevated slowly.The fetal catecholamine levels of group K boosted(P<0.01),which were unchanged in group F.The increase of blood cortisol levels in both groups was notable(P<0.05),which was not significantly different between two groups. All fetuses could not survive more than 2h. (Conclusion )Ketamine and fentanyl can not effectively ameliorate the stress responses of fetal lamb under fetal cardiopulmonary bypass. The severe stress response is detrimental to the survival of fetal lamb.

关 键 词：氯胺酮 芬太尼 麻醉 胎羊 心肺转流 应激反应 CPB 皮质醇 

分 类 号：R614[医药卫生—麻醉学]