艾司氯胺酮对儿童活体肝移植受者炎症因子及心肌损伤标志物的影响  

Effect of esketamine on inflammatory cytokines and myocardial injury markers in pediatric patients undergoing living-donor liver transplantation

作　　者：车璐 翁亦齐[1] 盛明薇[1] 贾莉莉[1] 吴玉立[1] 霍泓宇 喻文立[1] 许建刚[1] Che Lu;Weng Yiqi;Sheng Mingwei;Jia Lili;Wu Yuli;Huo Hongyu;Yu Wenli;Xu Jiangang(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China;First Central Clinical College,Tianjin Medical University,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院麻醉科,天津300192 [2]天津医科大学一中心临床学院,天津300192

出　　处：《中华器官移植杂志》2024年第5期337-342,F0003,共7页Chinese Journal of Organ Transplantation

基　　金：天津市多元投入基金面上项目(21JCYBJC01190)。

摘　　要：目的探索艾司氯胺酮对儿童肝移植受者炎症因子及心肌损伤标志物的影响。方法随机对照临床研究。选择2022年7月至2022年12月天津市第一中心医院收治的拟行活体肝移植术的胆道闭锁患儿50例。采用随机数字表法将其分为艾司氯胺酮组(E组,25例)和对照组(C组,25例)。E组儿童肝移植受者麻醉诱导时给予艾司氯胺酮0.5 mg/kg,麻醉诱导后以0.5 mg·kg-1·h-1剂量持续泵注艾司氯胺酮直至术毕。C组麻醉诱导及维持阶段使用相同剂量0.9%氯化钠注射液作为空白对照。记录两组受者的基本信息及诱导后5 min(T0)、无肝期30 min(T1)、新肝开放即刻(T2)、新肝期30 min(T3)、术毕(T4)时间点的心率、平均动脉压(mean arterial pressure,MAP)和中心静脉压;于T0、T1、T3、T4时采集中心静脉血样,检测血清心肌肌钙蛋白I(cardiac troponin I,cTnI)、肌酸激酶同工酶MB(creatine kinase isoenzyme-MB,CK-MB)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和白细胞介素-6(interleukin-6,IL-6)浓度。记录受者心脏不良事件的发生例数、术后机械通气时间、重症监护室停留时间及住院时间。组间比较采用独立样本t检验,组内各时点比较采用重复测量方差分析;非正态分布的计量资料以M(IQR)表示,组间比较采用非参数检验。结果C组和E组受者T2时的MAP分别为(39.3±8.0)mmHg(1 mmHg=0.133 kPa)和(48.6±12.7)mmHg,较T0时的(53.2±9.4)mmHg和(55.6±10.7)mmHg低,差异均有统计学意义(P值均<0.001);C组和E组T3时间点炎症因子TNF-α和IL-6浓度分别为169.0(207.1)ng/L和(132.63±51.75)ng/L、78.5(138.8)ng/L和(87.44±32.17)ng/L,分别较C组和E组T0时间点的43.8(26.4)ng/L和(51.79±17.83)ng/L、54.2(63.1)ng/L和(60.54±20.75)ng/L高,差异均有统计学意义(P值均<0.001)。C组T3、T4时间点心肌损伤标志物CK-MB和cTnI浓度分别较T0时间点升高[T3比T0:5.7(5.4)μg/L比4.0(3.5)μg/L,0.09(0.08)μg/L比0.02(0.02)μg/L;T4比T0:5.3(5.0)μg/L比4.0(3.5)Objective To explore the effect of esketamine on inflammatory cytokines and myocardial injury markers in children undergoing living-donor liver transplantation(LT).Methods Considering the inclusion criteria,50 children with biliary atresia were selected for living donor LT.They were equally randomized into two groups of control(C)and esketamine(E)(25 cases each).Esketamine 0.5 mg/kg was administered to group E during induction and continued at a dose of 0.5 mg·kg–1·h-1 after an induction of anesthesia.Group C provided the same dose of 0.9%sodium chloride injection during induction and then continued to pumping until the end of the procedure.Basic profiles of two groups were recorded.Hemodynamic parameters,such as heart rate(HR),mean arterial pressure(MAP)and central venous pressure(CVP),were monitored at 5 min of anesthesia induction(T0),30 min of anhepatic phase(T1),immediately after repercussion(T2),30 min of neohepatic phase(T3)and end of surgery(T4)in both groups.Central venous blood samples were collected at T0,T1,T3 and T4.Serum levels of cardiac troponin I(cTnI),creatine kinase isoenzyme-MB(CK-MB),tumor necrosis factor alpha(TNF-α)and interleukin-6(IL-6)were measured.The incidence of adverse cardiac events,postoperative mechanical ventilation time,ICU stay and hospitalization length were compared.Results As compared with T0,mean arterial pressure(MAP)at T2 declined markedly in group E[(48.6±12.7)mmHg(1 mmHg=0.133 kPa)vs(55.6±10.7)mmHg,P<0.001]and C[(39.3±8.0)mmHg vs(53.2±9.4)mmHg,P<0.001];As compared with T0,the TNF-αand IL-6 spiked at T3 in group C[169.0(207.1)ng/L vs 43.8(26.4)ng/L,(132.63±51.75)ng/L vs(51.79±17.83)ng/L,P<0.001]and E[78.5(138.8)ng/L vs 43.8(26.4)ng/L,(87.44±32.17)ng/L vs(51.79±17.83)ng/L,P<0.001];In group C,the concentration of myocardial injury markers CK-MB and cTnI rose at T3/T4 compared with T0[T3 vs T0:5.7(5.4)μg/L vs 4.0(3.5)μg/L,0.09(0.08)μg/L vs 0.02(0.02)μg/L;T4 vs T0:5.3(5.0)μg/L vs 4.0(3.5)μg/L,0.07(0.08)μg/L vs 0.02(0.02)μg/L,P<0.001].In group E,the leve

关 键 词：艾司氯胺酮 儿童 肝移植 心肌损伤 

分 类 号：R726.1[医药卫生—儿科]