【摘要】 目的观察亚麻醉剂量氯胺酮预处理对长时间CO2气腹所致肠损伤的影响。方法择期行腹腔镜下单纯脾切除手术、ASA分级I～Ⅱ级的病人60例,随机分为对照组和氯胺酮预处理组(试验组),每组各30例。CO2气腹时间120～150 min。试验组,推注全麻诱导药前2 min,肌肉注射氯胺酮1.0 mg.kg-1;对照组,以等量生理盐水代替。记录麻醉诱导前10 min(T0)、插管即刻(T1)、气腹即刻(T2)、气腹后1 h(T3)、气腹后2 h(T4)、气腹消除即刻(T5)、术后6 h(T6)、术后12 h(T7)的血压和心率;并在T0、T3、T4、T5、T6、T7抽取静脉血3 mL,离心取血清,用放射免疫法测定白细胞介素-6,8(IL-6、IL-8)、肿瘤坏死因子-α(TNF-α);ELISA试剂盒测定血清肠脂肪酸结合蛋白(I-FABP)浓度。结果在T3～T7时,2组的IL-6、IL-8、TNF-α、I-FABP浓度均升高,且与T0相比有显著差异(P﹤0.01);试验组的升高幅度较对照组小,2组比较有统计学差异(P﹤0.05)。结论亚麻醉剂量氯胺酮预处理,可减轻长时间高气腹压下肠组织的炎性反应,减轻肠粘膜缺血及再灌注性损伤,对肠损伤有一定保护作用。更多还原

【Abstract】 Objective To investigate the effects of subanesthetic dose of ketamine preconditioning on intestinal injury induced by long time carbon dioxide pneumoperitoneum.Methods Sixty ASA Ⅰor Ⅱ patients presenting for elective laparoscopic splenectomy in which carbon dioxide pneumoperitoneum lasted 120-150 min were enrolled in this study.Patients were randomly assigned into control group or ketamine preconditioning group(trial group).Each group contains 30 patients.Trial group received intramuscular ketamine 1.0 mg·kg-1 2 min prior to induction of anesthesia,control group received intramuscular saline with the same volume.The blood pressure and heart rate were monitored and recorded at 7 intervals: 10 min before induction of anesthesia(T0),at intubation(T1),at insufflation(T2),1 h after insufflation(T3),2 h after insufflation(T4),at carbon dioxide deflation(T5),6 h after surgery(T6),12 h after surgery(T7).3 mL venous blood samples were taken at T0,T3,T4,T5,T6 and T7.After centrifuge,the serum was obtained.The concentrations of IL-6,IL-8,TNF-α were measured by radioimmunoassay.The serum concentration of intestinal fatty acid binding protein(I-FABP) was measured by ELISA.Results The concentrations of IL-6,IL-8,TNF-α,I-FABP increased significantly at T3-T7 compared with T0 in both groups(P<0.01).The ascending extent in trial group was significantly smaller than that of control group(P<0.05).Conclusion Subanesthetic dose of ketamine preconditioning can reduce the inflammatory reaction caused by long time high pneumoperitoneal intra-abdominal pressure,decreases the the intestinal mucosal ischemia-reperfusion injury,protects intestinal against injury.更多还原