异丙酚静脉麻醉对大面积烧伤患者血小板聚集及凝血功能的影响  

The influence of intravenous target-controlled infusion of propofol on platelet and coagulation function in major burn patients during operation

作　　者：陈杰[1] 陶国才[1] 颜洪[2] 苏东[1] 毕敏[1] 

机构地区：[1]第三军医大学西南医院麻醉科,重庆400038 [2]第三军医大学全军烧伤研究所创伤,烧伤与复合伤国家重点实验室

出　　处：《中华烧伤杂志》2006年第2期101-104,共4页Chinese Journal of Burns

摘　　要：目的观察异丙酚静脉麻醉对大面积烧伤患者血小板聚集及凝血功能的影响。方法将55例大面积烧伤患者随机分为异丙酚组(30例)和氯胺酮组(25例),将30例健康献血者设为对照组。分别于麻醉诱导前和手术开始后0．5、1．0、2．0 h以及停药后1．0 h采血,用比浊法检测患者血小板聚集率;双波长荧光比值法检测血小板内游离Ca2+浓度([Ca2+]i);用血栓弹性描记仪测定血栓弹性描记图(TEG)的各项指标。结果麻醉诱导前异丙酚组、氯胺酮组、对照组血小板聚集率分别为(84±10)％、(80±7)％、(65±8)％,血小板[Ca2+]i分别为(341±12)、(331±32)、(132± 16)nmol/L,对照组明显低于其他两组(P<0．05或0．01);与麻醉诱导前比较,异丙酚组在手术开始后1．1、2．0 h及停药后两项指标明显降低(P<0．05或0．01),氯胺酮组明显升高(P<0．05或 0．01)。TEG结果显示,异丙酚组患者术前凝血功能的高凝状态缓解,术中保持相对稳定;氯胺酮组在术中及术后高凝状态进一步加重。结论患者烧伤后血小板被激活,血液处于高凝状态。在大面积烧伤手术中,异丙酚通过降低血小板内[Ca2+]i而抑制血小板聚集,稳定凝血功能状态。Objective To investigate the influence （TCI） of intravenous infusion of propofol on platelet aggregation and blood coagulation in major burn patients during operation. Methods Fifty-five major bum patients were randomly divided into propofol （P） and ketamine（K） groups. Blood samples were harvested before anaesthesia induction, 0.5 hour （h）, 1h, 2h following the beginning of the operation and 1 h after the end of the operation. Platelet aggregation rate was determined by turbidimetry. The free calcium concentration in the thrombocyte [ Ca^2＋ ]i was determined by double wave length fluorescent ratio. Thromboelastographic（TEG） indices were measured by thromboelastograph. Results （1） The platelet aggregation rate before anaesthesia induction was （84 ＋10）% , （80 ±7）% , and （65 ±8）% in P, K and control groups, respectively, while the [ Ca^2＋ ]i was （341 ± 12） , （331 ±32） and（ 132 ± 16） nmol/L in P, K and control groups, respectively. （2） Both platelet aggregation rate and [ Ca^2＋ ]i in control group were significantly lower than those in the other two groups （ P 〈0.05 or 0.01 ）. The above two indices in P group during and after the operation were obviously lower than those before anaesthesia induction （ P 〈 0.05 or 0.01 ） , while they increased evidently in K group （ P 〈 0.05 or 0.01 ）. （ 3 ） The hypercoagulability state of the blood indicated by TEG examination in P group before the operation was reduced and remained relatively stable during the operation, but that in K group enhanced during and after the operation. Conclusion （1） The thrombocyte was activated after burn injury and the blood became hypercoagulabale. （2） Propofol can stabilize blood coagulation function by lowering [ Ca^2＋ ] i and by inhibiting the aggregation of thrombocytes in major burn patients during the operation.

关 键 词：烧伤 麻醉 静脉 血小板聚集 异丙酚 游离钙 

分 类 号：R614[医药卫生—麻醉学]