氯胺酮对患者围术期β-内腓肽和白细胞介素-2的影响  

The Effects of Ketamine analgesia on patients' β-endorphin and interleukin-2 in perioperative period

作　　者：徐维娟[1] 徐维昉[2] 徐桂萍[1] 

机构地区：[1]新疆维吾尔自治区人民医院麻醉科,乌鲁木齐830001 [2]新疆医科大学第一附属医院麻醉科,乌鲁木齐830054

出　　处：《新疆医科大学学报》2012年第11期1515-1518,1522,共5页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金(2011211A056)

摘　　要：目的观察氯胺酮对围术期血浆β-内腓肽(β-EP)和血清白细胞介素-2(IL-2)分泌的影响。方法选择46例拟择期行腹部手术的患者,随机分为两组:对照组23例,常规行气管插管全身麻醉;氯胺酮组23例,气管插管全身麻醉诱导前10min静脉推注氯胺酮0.5mg/kg,术中给予氯胺酮0.25mg/kg,持续泵入。两组患者分别于麻醉前(T1)、切皮即刻(T2)、术毕即刻(T3)、术毕24h(T4)采血,用放免法检测血浆β-内啡肽(β-EP)水平,用酶联免疫吸附试验(ELISA)检测血清IL-2水平。患者入手术室后连续监测血压、心率、脉搏氧饱和度,记录T1、T2、T3及T4的平均动脉压、心率。手术结束后,连接静脉镇痛泵(芬太尼15μg·kg-1·100mL-1)持续背景量2mL/h,单次追加输注量2mL,锁定时间15min,于手术结束后4、12、24、48h分别观察术后镇痛情况及不良反应。结果 (1)两组患者麻醉前与麻醉后平均动脉压、心率在T1、T2、T3及T4各时点比较差异无统计学意义(P>0.05);(2)氯胺酮组T2、T3及T4时间点上血浆β-EP水平与对照组相比明显降低(P<0.05),血清IL-2水平与对照组相比明显升高(P<0.05);与麻醉前相比,两组患者各时间点血浆β-EP水平明显降低(P<0.05),血清IL-2水平明显升高(P<0.05);(3)氯胺酮组较对照组在术后4、12、24h及48hVAS疼痛评分均降低(P<0.05);(4)两组患者术后首次触发时间、按压有效进药次数、芬太尼总量比较差异有统计学意义(P<0.05);(5)氯胺酮组恶心呕吐、尿潴留高于对照组,差异无统计学意义(P>0.05)。结论氯胺酮可更好地减少由于疼痛引起的内源性β-EP释放,提高IL-2水平,减轻由于手术创伤及术后疼痛导致的应激反应和免疫抑制状态,有效降低围术期应激反应,增强术后镇痛效果。Objective To observe the effects of ketamine analgesia on the secretion of plasma β-endorphin（β-EP） and serum interleukin-2 in perioperative period.Methods The 46 patients undergoing abdominal surgery were divided into two groups randomly： the control group（GroupⅠ） and the group with ketamine analgesia（GroupⅡ）.The control group（groupⅠ）： patients were applied with normal tracheal intubation general anesthesia;the group with ketamine analgesia（GroupⅡ）： patients were applied with intravenous injection of 0.5 mg/kg ketamine 10 minutes before tracheal intubation general anesthesia induction and 0.25 mg/kg ketamine in continuous pumping way during operation.Take blood samples of all patients in two groups separately before anesthesia,suturing skin,after operation and 24 hours after operation.Measure plasma β-EP level by radioimmunoassay,serum IL-2 level by ELISA.At the same time,patients＇ blood pressure,heart rate,pulse oxygen saturation were monitored consecutively once after they were sent into operation room,average arterial pressure and heart rate at above-mentioned four time points were also recorded.Connect venous analgesic pump（fentanyl 15 μg·kg-1·100 mL-1）with consecutive background volume of 2 mL/h and single additional infused volume of 2 mL locked in 15 min after operation,observe postoperative analgesia effect and adverse reaction respectively 4,12,24,48 hours after operation.Results（1） Mean arterial pressure,heart rate in T1,T2,T3 and T4 each time have no statistical significance（P0.05） in two groups of patients before anesthesia and postoperative;（2） In two groups of patients before anesthesia and postoperative,plasma β-EP,the serum level of IL-2 content in 4 time points,ketamine group plasma β-EP levels compared with the control group decreased significantly,the difference was statistically significant（P0.05）,serum levels of IL-2 compared with the control group increased obviously,the difference was statistically significant（P0.05）.Compa

关 键 词：氯胺酮 Β-内腓肽 白细胞介素-2 

分 类 号：R614[医药卫生—麻醉学]