不同麻醉药物对兔严重烫伤早期炎性反应的影响  

Effect of different anesthetic on inflammatory cytokine balance in early stage of severe scalds in rabbits

作　　者：项尽一 夏建国 张昆 蒋筱杨 汪刚 

机构地区：[1]湖北省武汉市第三医院麻醉科,430060

出　　处：《重庆医学》2016年第24期3330-3333,共4页Chongqing medicine

基　　金：湖北省武汉市卫计委科研基金资助项目[武卫(2013)10.WX13B10]

摘　　要：目的探讨不同麻醉药物对兔严重烧伤早期炎性细胞因子变化的影响。方法 50只兔随机分为健康对照组(C组),烫伤对照组(SC组)、异丙酚组(P组)、氯胺酮组(K组)和异丙酚-氯胺酮组(PK组)。除C组外制成30%Ⅲ°烧伤面积(TBSA)烫伤模型,P组伤后持续泵注异丙酚20mg·kg-1·h-1 4h,K组氯胺酮20mg·kg^(-1)·h^(-1)4h、PK组异丙酚10mg·kg^(-1)·h^(-1)和氯胺酮10mg·kg^(-1)·h^(-1)4h;而C组和SC组仅补液处理。分别于烫伤前、烫伤后1、6、12、24h行血气分析并检测血清白细胞介素(IL)-1β、IL-6及肿瘤坏死因子-α(TNF-α)浓度。结果 SC组和药物干预组伤后二氧化碳分压(PaCO_2)比烫伤前和C组明显降低(P<0.01),氧分压(PaO_2)、乳酸(Lac)升高,而Lac水平高于烫伤前和C组(P<0.01),且在其后逐渐升高,但均在正常水平,pH值、PaO_2和血氧饱和度(SO_2)在各时间点与烫伤前比较差异无统计学意义(P>0.05)。烫伤后SC、药物干预组IL-1β、IL-6及TNF-α升高(P<0.05),麻醉药物干预后IL-1β、IL-6及TNF-α各时间点均比SC组降低(P<0.05)。PK组与P组及K组相比IL-1β、IL-6及TNF-α升高较少,组间差异有统计学意义(P<0.05)。结论异丙酚复合氯胺酮麻醉能更有效地抑制兔严重烧伤早期全身性炎症反应。Objective To explore the influences of different anesthetic on inflammatory cytokine balance in early stage of se- vere injury in rabbits. Methods Fifty healthy New Zealand rabbits were randomly divided into 5 groups（n= 10）： control group （group C）,scald control group（group SC）, propofol anesthesia group （group P）, ketamine anesthesia group（group K）, propofol- ketamine anesthesia group （group PK）. All rabbits except group C were suffered from 30% Ⅲ °TBSA scald,In group P,K and PK, rabbits were constantly infused with total intravenous anesthesia of propofol 20 mg·kg^-1·h^-1 （group P）, ketamine 20 mg·kg^-1·h^-1（group K） ,propofol 10 mg·kg^-1·h^-1 and ketamine 10 mg ·kg^-1·h^-1 （group PK）for 4 h. The group C and the SC only underwent fluid infusion. Blood samples were preserved before scald and 1,6,12,24 h after scald. Arterial blood gas and con- centrations of IL-1β, IL-6 and TNF-α in blood serum were determined. Results PaCOz were decreased and PaO2 .Lac were increased in group SC,P,K and PK,but the level of Lac went up after scald and then tended to be stable,concentration of Lae in group SC, P,K and PK increased higher than group C （P〈0.01）. Comparison of pH value,PaO2 ,SO2 between group SCand group P,K, PK did not show statistically significant at each time point（P〉0.05）. The levels of IL-1β,IL-6 and TNF-α were markedly higher in group SC,P,K,PK than those of group C（P〈0.05） ,the serum levels of cytokines were significantly lower in group P,K and PK than those of group SC（P〈0.05）. Comparison of different anesthetic group, the level of IL-1β, IL-6 and TNF-α was mgnifieantly lower in group PK than those of group P and K. Intergroup comparison showed significant difference（P〈0.05）. Conclusion The results suggest that propofol and ketamine anesthesia may effectively inhibit systemic inflammatory response to a certain extent in early stage of severe scald.

关 键 词：异丙酚 氯胺酮 严重烧伤 细胞因子 

分 类 号：R614[医药卫生—麻醉学]