艾司氯胺酮对亲体肝移植术患儿术后急性肺损伤的影响  

Effect of esketamine on postoperative acute lung injury in pediatric patients undergoing living donor liver transplantation

作　　者：丁梅[1] 裴平 翁亦齐[1] 刘伟华[1] 李津源[1] 盛明薇[1] 张桂诚 喻文立[1] Ding Mei;Pei Ping;Weng Yiqi;Liu Weihua;Li Jinyuan;Sheng Mingwei;Zhang Guicheng;Yu Wenli(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China;Department of Surgery,Nankai University Affiliated Hospital(Tangjin Fourth Hospital),Tianjin 300222,China)

机构地区：[1]天津市第一中心医院麻醉科,天津300192 [2]南开大学附属医院(天津市第四医院)外科,天津300222

出　　处：《中华麻醉学杂志》2023年第10期1164-1169,共6页Chinese Journal of Anesthesiology

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-045A);天津市卫生健康委员会科技项目(ZC20223)。

摘　　要：目的评价艾司氯胺酮对亲体肝移植术患儿术后急性肺损伤(ALI)的影响。方法收集胆道闭锁亲体肝移植术患儿60例,0~36月龄,ASA分级Ⅰ~Ⅲ级,心功能分级Ⅰ或Ⅱ级,Child-Pugh分级B或C级,性别不限。采用随机数字表法将其分为2组(n=30):对照组(C组)和艾司氯胺酮组(S组)。2组均采用丙泊酚与七氟烷静吸复合麻醉,S组于诱导后持续静脉输注艾司氯胺酮。于麻醉诱导后(T_(0))、手术开始后60 min(T_(1))、无肝期后10 min(T_(2))、门静脉开放60 min(T_(3))和关腹即刻(T_(4))时采集中心静脉血样,采用ELISA法测定血清克拉拉细胞分泌蛋白16(CC16)、表面活性蛋白(SP-D)、高级糖基化终末产物可溶性受体(s-RAGE)、高迁移率族蛋白B1(HMGB1)、IL-1β和TNF-α浓度;采用TBA法测定MDA浓度,羟胺法测定SOD活性,记录肺动态顺应性(Cdyn);于T_(0~4)和术后24 h(T_(5))时抽取桡动脉血样行血气分析,计算氧合指数(OI)和呼吸指数(RI);术前24 h及T_(5)时记录肺部超声(LUS)评分;记录术后机械通气时间和ICU停留时间;观察肝移植患儿术后7 d内ALI发生情况。结果与C组比较,S组T_(3),4时血清CC16、SP-D、s-RAGE、HMGB1、IL-1β、TNF-α和MDA浓度降低,SOD活性升高,T_(3~5)时OI升高,RI降低,T_(5)时LUS C评分和B评分降低,术后机械通气时间和ICU停留时间缩短,ALI发生率降低(P<0.05)。结论艾司氯胺酮可减轻亲体肝移植术患儿术后ALI。Objective To evaluate the effect of esketamine on postoperative acute lung injury(ALI)in pediatric patients undergoing living donor liver transplantation.Methods Sixty pediatric patients of either sex with biliary atresia,aged 0-36 months,of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ,with cardiac function grade I orⅡ,with Child-Pugh grade B or C,undergoing living donor liver transplantation,were divided into 2 groups(n=30 each)using a computer-generated table of random numbers:control group(group C)and esketamine group(group S).Combined intravenous-inhalational anesthesia was performed with propofol and sevoflurane in both groups,and in addition esketamine was intravenously infused continuously after induction in group S.After anesthesia induction(T_(0)),at 60 min after start of surgery(T_(1)),at 10 min after anhepatic phase(T_(2)),at 60 min after portal vein opening(T_(3)),and immediately after abdominal closure(T_(4)),central venous blood samples were collected for determination of the serum concentrations of Clara cell secretory protein 16,surface active protein D,soluble receptor for advanced glycation end-products,high mobility group protein B1,interleukin-1beta and tumor necrosis factor-alpha(using enzyme-linked immunosorbent assay),concentrations of malondialdehyde(using TBA method),and activity of superoxide dismutase(using hydroxylamine method).The dynamic lung compliance was recorded from T_(0) to T_(4).Blood samples were taken from the radial artery at T_(0) and 24 h after surgery(T_(5))for blood gas analysis,and oxygenation index and respiratory index were calculated.Lung ultrasound scores were recorded at 24 h before surgery and T_(5).The postoperative mechanical ventilation time and duration of intensive care unit stay were recorded.The occurrence of ALI within 7 days after liver transplantation was observed.Results Compared with group C,the serum concentrations of Clara cell secretory protein 16,surface active protein D,soluble receptor for advanced glycation end

关 键 词：氯胺酮 肝移植 儿童 急性肺损伤 

分 类 号：R726.1[医药卫生—儿科]