胸科手术患者单肺通气前氯胺酮雾化吸入对肺保护的效果  

Ketamine inhalation before one-lung ventilation for perioperative lung protection in thoracic surgery patients

作　　者：王丽君[1] 顾连兵[1] 蒋大明[1] 高蓉[1] 许仄平[1] 万梅方[1] 鲁振[1] 

机构地区：[1]江苏省肿瘤医院麻醉科,南京210009

出　　处：《中华医学杂志》2013年第11期832-836,共5页National Medical Journal of China

基　　金：江苏省自然科学基金（BK2010588）;江苏省肿瘤医院青年基金资助项目（ZQ200906）

摘　　要：目的探讨胸科手术患者单肺通气前氯胺酮雾化吸入的肺保护效果。方法选择2010年3月至2011年6月在江苏省肿瘤医院手术室，择期行经左胸食管中段癌根治术患者90例，美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，经医院伦理委员会批准，采用随机数字表法均分为3组：氯胺酮雾化组（Ki组，n=30），氯胺酮静脉组（Kv组，n=30），对照组（C组，n=30）。静脉全麻双腔支气管插管后，Ki组给予氯胺酮雾化吸入（氯胺酮用量为1mg／kg，用生理盐水稀释至10m1），Kv组通过静脉输注氯胺酮（氯胺酮用量为1mg／kg，用生理盐水稀释至10m1），C组给予10ml生理盐水雾化吸入。分别于雾化吸入前（T1）、单肺通气30min（T2）、单肺通气60min（T3）、单肺通气120min（T4）、单肺通气结束5min（T5）、手术结束（T6）时抽取桡动脉血，行动脉血气分析，记录脉搏氧饱和度（SpO2）、呼气末二氧化碳（P_ET CO2）、气道压（Paw）及血流动力学指标。于T1、T2、手术结束2h（17）抽取中心静脉血，检测血中自细胞介素-6（IL-6）、白细胞介素一8（IL-8）、可溶性细胞间黏附分子-1（sICAM-1）水平。结果随着时间的延长，3组患者血清IL-6[Ki组T1（214±45）、T2（244±50）、T7（321±50）ng／L；Kv组T1（216±37）、T2（246±56）、T7（320±52）ng／L]、IL-8、ICAM-1水平均较前-时间点明显升高；Ki组和Kv组患者，17时的血清IL．6、IL-8、ICAM-1水平明显低于c组[（356±34）ng／L，（224±44）ng／L，（248±44）斗μg/L]。Ki组和Kv组患者T4时的动脉血Pa02显著高于C组。Kv组患者他-T4时的SBP、DBP显著高于Ki组和C组。Kv组患者他、T3时的心率显著高于C组。T2-T6时点Kv组的Paw均显著高于C组。结论单肺通气前经雾化吸入和静脉输注氯胺酮都能有效降低血中IL-6、IL-8、sICAM-1水平，而雾化吸入则进一步避免了对心血管系统和气道压的不良影响�Objective To explore the effects of ketamine inhalation before one-lung ventilation （OLV） in patients undergoing transthoraeic esophageetomy for esophageal cancer. Methods Upon the approval of hospital ethic committee, 90 American Society of Anesthesiologists grade Ⅰ- Ⅱ patients scheduled for elective trans-lefl-thoracic esophageetomy for esophageal cancer were randomly and single- blindly divided into 3 groups. After intravenous anesthesia with double-lumen endobronchial intubation, the patients in each group received different therapies before OLV, i.e. inhaling ketamine 1 mg/kg in Group Ki, intravenous infusion of kemamine 1 mg/kg in Group Kv and inhaling normal saline 10 ml in Group C. Arterial blood gas analysis was performed. And （ oxygen saturation） SpOz, （ partial pressure of end-tidal carbon dioxide） PETC02, （airway pressure） Paw and hemodynamie indicators were recorded at these points： before OLV （T1）, OLV for30 min （T2）, OLV for 1 h （T3）, OLV for2 h （T4）, OLV ended 5 min （T5） and end of surgery （T6）. Central venous blood was sampled at T1, T2 and 2 h after surgery （T7） for the determination of interleukin-6 （ IL-6）, interleukin-8 （ IL-8 ） and soluble intercellular adhesion molecule-1 （sICAM-1） concentrations by enzyme-linked immunosorbent assay （ELISA）. Results Serum levels of IL-6, 11,-8 and sICAM-1 in all groups inereased significantly than those at previous timepoints. Serum levels of IL-6, TL-8 and slCAM-1 in Groups Ki and Kv were significantly lower than those in Group C at T7. PaO2 in Groups Ki and Kv was significantly higher than that in Group C at T4. Systolic blood pressure （SBP） and diastolic blood pressure （DBP） in Group Kv were significantly higher than that in Groups Ki and C at T2 - T4; HR in Group Kv was significantly higher than that in Group C at T2 -T3. Paw in Group Kv was significantly higher than that in Group C at T2 -T6. Conclusion Inhalation and intravenous infusion of ketaminc before OLV are equally effect

关 键 词：氯胺酮 食管肿瘤 细胞因子类 超声雾化吸入 

分 类 号：R614[医药卫生—麻醉学]