氯胺酮对高位脊髓损伤后循环系统紊乱的保护  

The protective effect of ketamine on circulatory system disorders after high4ever spinal cord injury in rats

作　　者：夏建华[1] 刘珍秀[2,3] 盛睿方[1] 普隽[4] 岑奕[1] 曹霞[1] 

机构地区：[1]解放军第411医院麻醉科,上海200081 [2]徐州医学院江苏省麻醉学重点实验室 [3]江苏省麻醉与镇痛应用技术重点实验室 [4]第二军医大学长征医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2014年第10期897-901,共5页International Journal of Anesthesiology and Resuscitation

基　　金：全军医学科技“十二五”科研项目（CWSl1J026）

摘　　要：目的研究高位脊髓损伤（spinal cord injury，SCI）后氯胺酮（ketamine，KT）对循环系统紊乱的保护作用。方法健康雄性SD大鼠20只，通过抽签将大鼠随机分为单纯SCI组（SCI组）、SCI后给予KT治疗组（SCI＋KT组）、对照组（Sham组）和对照给予KT治疗组（Sham＋KT组），每组5只。SCI大鼠采用改良Allens打击法建立脊髓胸4节段损伤动物模型，Sham组仅咬除椎板，未打击脊髓。SCI＋KT组和Sham＋KT组分别在手术处理后24h开始给予KT腹腔注射1mg·kg-1·d-1。观察处理前后1周～6周大鼠平均动脉压（mean arterial pressure，MAP）、心率（heatrate，HR）、24h尿中去甲肾上腺素（noradenaline，NA）的变化，以及6周后大鼠左心室内压变化最大速率（1eft ventricular internal pressure maximum rate of change，±dp／dtmax）和苏木精伊红（hematoxylin and eosin，HE）心肌染色的变化。结果术后1周SCI组大鼠MAP为（90±4）mmHg（1mmHg=0.133kPa），较Sham组明显降低，同时伴有HR增至（518±11）次／min、尿中NA减少、6周后左心室内压最大上升速率（1eft ventricular internal pressure maximum rising rate，＋dp／dtmax）增大、心肌纤维化明显（P〈0.05）；SCI＋KT组较SCI组MAP升高至（106±4）mmHg、HR下降到（459±10）次／min、尿中NA增多、6周后＋dp／dtmax减小、心肌纤维化程度明显减轻（P〈0.05）。结论SCI后使用KT可以改善血流动力学指标，从而改善大鼠心肌收缩力，减轻心肌细胞损伤，而这种作用可能是通过增加机体NA含量实现的。Objective To study the protective effect of ketamine（KT） on circulatory system disorders after high-level spinal cord injury （SCI） in rats. Methods Twenty male 18-week-old SD rats weighing 290 g-310 g were randomly divided into 4 groups （n=5）： SCI group, SCI＋KT group, Sham group and Sham＋KT group. The animals in SCI and SCI＋KT groups were subjected to SCI at T4 according to modified Allen＇s method. The operations for Sham group and Sham＋KT group were preformed without stroking spinal cord. Twenty-four hours after the operation, SCI＋KT group and Sham＋KT group were treated with ketamine 1 mg·kg-1·d-1, daily lasting 6 weeks. Mean arterial pressure（MAP）, heat rate（HR） and the level of noradenaline（NA） in urine were recorded once a week for 6 weeks. At the end of 6 weeks post operation, left ventricular internal pressure maximum rate of change （±dp/dtmax） were recorded and myocardial specimen was sampled from left ventricle to study myocardial histology with HE staining. Results In SCI group, the animal＇s MAP[ （90±4） mmHg（ 1 mmHg=0.133 kPa ） ] and NA level were significantly lower and HR[ （518±11 ） bpm ] were significantly faster starting from 1 week post SCI compared with Sham group. Left ventricular internal pressure maximum rising rate （＋dp/dtmax） were significantly increased 6 weeks post SCI. However, in SCI＋KT group, the animals＇ MAP increased to （106±4） mmHg, HR decreased to （459±10） bpm, and ＋dp/dtmax and NA lever changed significantly （P〈0.05）. Ultrastrueture Of myocardial tissue presented abnormal changes in SCI groups,but the changes in SCI＋KT group were milder. Conclusions High-level spinal cord injury could induce the disorders of circulatory system. Ketamine can increase NA lever and improve hemodynamies and myocardial function after SCI.

关 键 词：脊髓损伤 氯胺酮 去甲肾上腺素 循环系统 

分 类 号：R651.2[医药卫生—外科学]