异丙酚-氯胺酮麻醉对兔严重烧伤早期细胞因子平衡的影响

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摘要

[摘要]目的探讨异丙酚-氯胺酮对兔严重烧伤早期细胞因子的影响。方法选取雄性新西兰兔30只，随机分为正常对照组（C组）、烧伤对照组（BC组）和异丙酚-氯胺酮麻醉组（PK组），每组10只。烧伤前1 d用戊巴比妥钠麻醉后颈内静脉、颈外动脉置管备用，实验当天将BC组和PK组兔制成30%体表总面积（TBSA）3度烧伤模型。PK组于伤后1 h静脉注射异丙酚1.5 mg/kg，90 s后行气管内插管，接麻醉机半紧闭供氧，保留自主呼吸，静脉泵注异丙酚 0.15 mg/（kg·min）和氯胺酮 0.15mg/（kg·min）维持麻醉，麻醉 4 h后停药。C组输入乳酸钠林格液，输入量：80 ml/（d·kg）；BC组和 PK组输入晶胶体（1∶1），补液量为 1.75×烧伤面积（%TBSA）×体重+80 ml/（d·kg）。三组在烧伤前、烧伤后1、6、12、24 h这5个时间点采集动脉血行血气分析，静脉采血检测血清白细胞介素-1（IL-1）、IL-6及肿瘤坏死因子-α（TNF-α）浓度。结果 BC、PK组的输液量比较，差异无统计学意义（P＞0.05），与C组比较，BC、PK组的输液量显著增多，差异有统计学意义（P＜0.05）。BC、PK组烧伤后的PaCO2比C组明显降低（P＜0.05）；BC、PK组烧伤后的Lac比烧伤前显著升高（P＜0.05），PK组较BC组显著降低（P＜0.05）；血pH值、PaO2和SaO2在各时间点与烧伤前比较，差异无统计学意义（P＞0.05）；烧伤后，BC、PK组的IL-1、IL-6、TNF-α浓度较烧伤前显著升高（P＜0.05），PK组采用异丙酚-氯胺酮麻醉处理后的 IL-1、IL-6及 TNF-α 在烧伤后 6、12、24 h时均比 BC组降低（P＜0.05）。结论异丙酚-氯胺酮麻醉能有效地降低血清细胞因子的水平，对严重烧伤早期的全身性炎症反应有一定的抑制作用，同时可改善组织灌注，有利于严重烧伤早期的复苏。

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异丙酚, 氯胺酮, 严重烧伤, 细胞因子

Abstract：[Abstract]Objective To investigate the influence of Propofol-Ketamine anesthesia on cytokine balance in early stage of severe burn in rabbits.Methods Thirty male New Zealand rabbits were selected and they were randomly divided into normal control group(group C,n=10),burn control group(group BC,n=10)and Propofol-Ketamine anesthesia group(group PK,n=10).The internal jugular vein and external carotid artery were placed in the tube after anesthesia with Sodium Pentobarbital a day before burn.On the day of the experiment,the rabbits in group BC and group PK were made into 30%body surface area (TBSA)3 degree burn models.In group PK,Propofol 1.5 mg/kg was injected intravenously 1 hours after injury,then endotracheal intubation 90 s later,next half closed oxygen supply with anesthesia machineopen,retaining spontaneous breathing,Propofol of 0.15 mg/(kg·min)and Ketamine of 0.15 mg/(kg·min)were infused intravenously to maintain anesthesia,and the drugs were discontinued after 4 hours of anesthesia.Group C was injected Sodium lactate Ringer solution,and the input volume was 80 ml/(d·kg).Group BC and PK were injected crystal colloid(1∶1),and the volume of fluid infusion was 1.75×(%TBSA)×weight+80 ml/(d·kg).Before burn and 1,6,12 and 24 hours after burn,arterial blood was collected for blood gas analysis,and serum levels of interleukin-1 (IL-1),interleukin-6(IL-6)and tumor necrosis factor-α (TNF-α)concentration were measured by venous blood sampling.Results There was no significant difference in the volume of transfusion between group BC and PK(P＞0.05).Compared with group C,the volume of transfusion in group BC and PK increased significantly,and the differences were statistically significant(P＜0.05).PaCO2in group BC and PK after burn was significantly lower than that in group C(P＜0.05).Lac in group BC and PK after burn was significantly higher than that before burn (P＜0.05),and group PK was significantly lower than that group BC (P＜0.05).There was no significant difference in pH,PaO2and SaO2at any time points compared with that before burn (P＞0.05).IL-1,IL-6 and TNF-α in group BC and PK after burn were significantly higher than those before burn (P＜0.05).Group PK anaesthetized by Propofol-Ketamine,the concentration of IL-1,IL-6 and TNF-α in group PK were lower than those in group BC at 6,12 and 24 h after burn (P＜0.05).Conclusion Propofol-Ketamine anesthesia can effectively reduce the level of serum cytokines,inhibit systemic inflammatory response in the early stage of severe burn,at the same time,it can improve tissue perfusion,which is conducive to early recovery of severe burn.

Key words： Propofol Ketamine Severe burn Cytokine

引用本文:

张昆;夏建国. 异丙酚-氯胺酮麻醉对兔严重烧伤早期细胞因子平衡的影响[J]. 中国当代医药, 2019, 26(7): 13-16.

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