氯胺酮麻醉对脑葡萄糖代谢的影响  

The effects of ketamine anesthesia on human cerebral glucose metabolism

作　　者：孙绪德[1] 陈蕾[2] 徐礼鲜 张惠 柴伟[1] 张贵和[1] 高昌俊[1] 韩丽春[1] 

机构地区：[1]第四军医大学唐都医院麻醉科,西安市710038 [2]第四军医大学海军总医院妇产科,西安市710038 [3]第四军医大学口腔医院麻醉科,西安市710038

出　　处：《实用医学杂志》2007年第8期1137-1139,共3页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:30271257)

摘　　要：目的:应用正电子发射断层显像技术(positron emission tomography,PET),研究全麻药氯胺酮对人脑能量代谢的影响,探讨氯胺酮作用的敏感脑区,为进一步阐明全麻机制提供理论依据。方法:选择健康志愿者10名,每名志愿者分别做3次PET扫描,采用PhilipsCPETPlus扫描仪及18FDG标记技术测定脑葡萄糖代谢(CMGlu),第1次在清醒状态下扫描作为对照,第2、3次分别在氯胺酮血浆药物浓度为0.2μg/mL(镇静状态)和1.1μg/mL(意识消失)时进行扫描。结果:(1)与清醒状态时比较,镇静状态下除惊觉/镇静评分明显降低(P<0.05)外,MAP、RR、HR和呼气末二氧化碳分压(PETCO2)等指标均升高,差异具有显著性。(2)镇静状态下全脑CMGlu降低了12.7%,CMGlu降低在丘脑、海马、额叶、枕叶和颞叶区域最为明显(P<0.05);在意识消失状态下全脑CMGlu降低了18.5%(P<0.05),其中丘脑、海马、颞叶、枕叶和额叶降低更为显著(P<0.05);其他区域没有明显的变化。结论:氯胺酮低剂量时首先影响皮层区,较高剂量时不仅影响皮层区域的能量代谢,也影响皮层下结构,特别是丘脑和海马等区域,这些区域可能是氯胺酮麻醉作用的关键靶位。Objective To study the effects of ketamine on human cerebral glucose metabolism （CMGlu） using positron emission tomogrephy （PET） and to provide theoretical support for further illustrating the mechanism of general anesthesia by investigating the cerebral region sensitive to the action of sevoflurane. Methods PET scans were performed thrice on each of the 10 healthy volunteers to detect their CMGlu. The first scan assessed the baseline metabolism and the other two were conducted during general anesthesia with ketamine in concentrations of 0.2μg/mL and 1.1μg/mL. Results （1） There were significant differences between the state of consciousness and sedation, with an increase in MAP, RR, HR and PETCO2 but a marked decrease in OAA/S （P 〈 0.05） under the sedative condition. （2） CMGlu was reduced by 12.7% in the whole cerebrum under the state of sedation with a most evident reduction in thalamus, hippocampus, frontal, occipital and temporal lobe（P 〈 0.05）. CMGlu was decreased by 18.5% in the whole cerebrum （P 〈 0.05） under the state of unconsciousness with a more marked fall in thalamus, hippoeampus, temporal, occipital, and temporal lobe（P 〈 0.05）. No significant changes of CMGlu occurred in other areas. Conclusion At a low dose ketamine first affects cortex, and at a higher dose, not only affects CMGlu in the cortex, but also affects subcortical formations, especially thalamus and hippocampus, which may be the key target sites of the anesthetic action of sevoflurane.

关 键 词：氯胺酮 正电子发射断层显像术 葡萄糖 脑代谢 麻醉药 

分 类 号：R614[医药卫生—麻醉学]