氯胺酮对体外循环下心脏手术患者术后早期认知功能的影响  

The Effect of Ketamine on the Early Cognitive Function of the Patients after Accepting Cardiac Surgery with Cardiopulmonary Bypass

作　　者：吴金丽[1] 曾祥刚[1] 姚茵[1] 欧炜[1] 谭立[1] 

机构地区：[1]贵阳医学院附院麻醉科,贵州贵阳550004

出　　处：《贵阳医学院学报》2012年第2期162-166,共5页Journal of Guiyang Medical College

摘　　要：目的:观察两种不同剂量的氯胺酮对在体外循环(CPB)下青壮年患者术后早期认知功能(POCD)的影响。方法:择期在CPB下行心脏瓣膜置换手术的青壮年患者45例,随机分为对照组(C组),氯胺酮1组(K1组)和氯胺酮2组(K2组),3组患者均以咪达唑仑、芬太尼、维库溴铵进行麻醉诱导及维持;K1组诱导后静脉注射氯胺酮1 mg/kg,继以20μg/(kg.min)持续输注至手术结束;K2组诱导后静脉注射氯胺酮0.5 mg/kg,继以10μg/(kg.min)持续输注至手术结束;C组给予等量生理盐水;在麻醉前(T0)、麻醉诱导后(注射氯胺酮前,T1)、CPB后20 min(T2)、CPB结束(T3)、术毕(T4)、术后24 h(T5)6个时间点分别取动脉及颈静脉球部血进行血气分析,计算脑氧摄取率(CEO2)及测定血浆S-100β蛋白、神经特异性烯醇化酶(NSE)含量;于术前1天和术后第7天应用认知能力筛查量表(CASI)进行测验,评价患者术后认知功能。结果:C组2例、K1组3例、K2组1例发生POCD,差异无统计学意义(P>0.05);与C组比较,K1、K2组CEO2在T2～T4时点降低(P<0.05);与C组相比,K1和K2组S-100β蛋白浓度在T2～T5各时点均降低(P<0.05);与C组相比,K1和K2组NSE浓度在T3～T5各时点均降低(P<0.05)。结论:麻醉剂量与亚麻醉剂量的氯胺酮不影响CPB下心脏手术患者术后早期认知功能障碍的发生率,对CPB下心脏手术引发的脑损伤具有一定保护作用。Objective： To observe the effects of two different doses of ketamine on the early cognitive function of the middle-aged and the youth after accepting cardiac surgery with cardiopulmonary bypass（CPB）.Methods： Forty-five patients（the middle-aged and the youth） undergoing cardiac valve replacement with CPB were randomly divided into three groups with 15 cases in each： control group（group C）,ketamine 1 group（group K1） and ketamin 2 group（group K2）.Aneasthesia was induced and maintained with midazolam,fentanyl and vecuroniumbromide in these three groups.In group K1,a bolus dose of ketamine（1 mg/kg） was given intravenously followed by continuous infusion of 20μg/（kg·min） throughout the operation;In group K2,a bolus dose of ketamine（0.5 mg/kg）was given intravenously followed by continuous infusion of 10μg/（kg·min）throughout the operation.In control group,normal saline was given in the same volume and at the same speed.Blood samples were taken from radial artery and jugular vein bulb before anesthesia（T0）,after induction of anesthesia（before ketamine injection）（T1）,20 minutes after CPB（T2）,at the end of CPB（T3）,at the end of operation（T4） and 24 hours after operation（T5）.At each time point,the changes of arterial and jugular venous hemoglobin saturation were observed and CEO2 was calculated,and plasma S-100β protein concentration and NSE were determined.Patients were tested at one day before and seven days after surgery by CASI,postoperative cognitive dysfunction was defined as the score of CASI after surgery was lower than the standard deviation before surgery.Results： POCD occurred in six patients： two in group C,three in group K1 and one in group K2.There was no statistical difference of the incidence（P0.05）.CEO2 in group K1 and group K2 was obviously lower than that in group C at T2~T4（P0.05）.S-100β protein concentrations in groups K1 and K2 were significantly lower than those in group C at T2~T5（P0.05）.the NSE concentrations

关 键 词：氯胺酮 体外循环 认知 心脏外科手术 

分 类 号：R654.1[医药卫生—外科学] R614.24[医药卫生—临床医学]