亚麻醉剂量氯胺酮预处理对长时间CO_2气腹所致肠损伤的影响  

Effects of subanesthetic dose of ketamine preconditioning on intestinal injury induced by long time carbon dioxide pneumoperitoneum

作　　者：严六狮[1] 袁伟[1] 王伟[1] 刘齐宁[1] 

机构地区：[1]西安交通大学医学院第一附属医院麻醉科,西安710061

出　　处：《中国临床药理学杂志》2012年第7期505-507,515,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的观察亚麻醉剂量氯胺酮预处理对长时间CO2气腹所致肠损伤的影响。方法择期行腹腔镜下单纯脾切除手术、ASA分级I～Ⅱ级的病人60例,随机分为对照组和氯胺酮预处理组(试验组),每组各30例。CO2气腹时间120～150 min。试验组,推注全麻诱导药前2 min,肌肉注射氯胺酮1.0 mg.kg-1;对照组,以等量生理盐水代替。记录麻醉诱导前10 min(T0)、插管即刻(T1)、气腹即刻(T2)、气腹后1 h(T3)、气腹后2 h(T4)、气腹消除即刻(T5)、术后6 h(T6)、术后12 h(T7)的血压和心率;并在T0、T3、T4、T5、T6、T7抽取静脉血3 mL,离心取血清,用放射免疫法测定白细胞介素-6,8(IL-6、IL-8)、肿瘤坏死因子-α(TNF-α);ELISA试剂盒测定血清肠脂肪酸结合蛋白(I-FABP)浓度。结果在T3～T7时,2组的IL-6、IL-8、TNF-α、I-FABP浓度均升高,且与T0相比有显著差异(P﹤0.01);试验组的升高幅度较对照组小,2组比较有统计学差异(P﹤0.05)。结论亚麻醉剂量氯胺酮预处理,可减轻长时间高气腹压下肠组织的炎性反应,减轻肠粘膜缺血及再灌注性损伤,对肠损伤有一定保护作用。Objective To investigate the effects of subanesthetic dose of ketamine preconditioning on intestinal injury induced by long time carbon dioxide pneumoperitoneum.Methods Sixty ASA Ⅰor Ⅱ patients presenting for elective laparoscopic splenectomy in which carbon dioxide pneumoperitoneum lasted 120-150 min were enrolled in this study.Patients were randomly assigned into control group or ketamine preconditioning group（trial group）.Each group contains 30 patients.Trial group received intramuscular ketamine 1.0 mg·kg-1 2 min prior to induction of anesthesia,control group received intramuscular saline with the same volume.The blood pressure and heart rate were monitored and recorded at 7 intervals： 10 min before induction of anesthesia（T0）,at intubation（T1）,at insufflation（T2）,1 h after insufflation（T3）,2 h after insufflation（T4）,at carbon dioxide deflation（T5）,6 h after surgery（T6）,12 h after surgery（T7）.3 mL venous blood samples were taken at T0,T3,T4,T5,T6 and T7.After centrifuge,the serum was obtained.The concentrations of IL-6,IL-8,TNF-α were measured by radioimmunoassay.The serum concentration of intestinal fatty acid binding protein（I-FABP） was measured by ELISA.Results The concentrations of IL-6,IL-8,TNF-α,I-FABP increased significantly at T3-T7 compared with T0 in both groups（P〈0.01）.The ascending extent in trial group was significantly smaller than that of control group（P〈0.05）.Conclusion Subanesthetic dose of ketamine preconditioning can reduce the inflammatory reaction caused by long time high pneumoperitoneal intra-abdominal pressure,decreases the the intestinal mucosal ischemia-reperfusion injury,protects intestinal against injury.

关 键 词：氯胺酮 气腹 炎性反应 手术并发症 

分 类 号：R971.2[医药卫生—药品] R574[医药卫生—药学]