CAJ | 학술논문

目的评价氯胺酮对体外循环瓣膜置换术患者外周血表面黏附分子CR3表达水平和中性粒细胞(PMN)内炎症介质cAMP浓度的影响.方法 60例体外循环(CPB)下瓣膜置换术患者随机平均分成4组,分别为对照组、氯胺酮Ⅰ组、氯胺酮Ⅱ组和氯胺酮Ⅲ组(n=15),体外循环前10 min经颈内静脉分别给以生理盐水(对照组)、氯胺酮Ⅰ组(0.1 mg/kg)、氯胺酮Ⅱ组(0.5 mg/kg)和氯胺酮Ⅲ组(1.0 mg/kg),并分别在麻醉诱导前即刻(T1)、体外循环开始前10 min(T2)、体外循环结束即刻(T3)、体外循环结束后24 h(T4)不同时点从颈内静脉采血,用流式细胞仪检测CB3表达情况,高效液相色谱法测定cAMP和cGMP浓度,观察患者心率、血压的变化和血管活性药物的使用情况.结果 T1,T2时点各组测量指标差异无统计学意义(P>0.05).T3,T4时点,与对照组相比,各氯胺酮试验组患者外周血CR3表达均降低(P<0.05),其中氯胺酮Ⅱ组和氯胺酮Ⅲ组水平更低于氯胺酮Ⅰ组(P<0.05).T3,T4时点,与对照组和氯胺酮Ⅰ组相比,氯胺酮Ⅱ和氯胺酮Ⅲ组患者外周血PMN内cAMP浓度均增高(P<0.05).T3时点,与对照组和氯胺酮Ⅰ组相比,氯胺酮Ⅱ组和氯胺酮Ⅲ组患者外周血PMN内cGMP浓度均降低(P<0.05).T4时点,与对照组和氯胺酮Ⅰ组患者相比,氯胺酮Ⅱ和氯胺酮Ⅲ组患者的平均动脉压(MAP)升高(P<0.05).氯胺酮Ⅲ组比其他各组术后使用更少的血管活性药(P<0.05).结论氯胺酮可一定程度地降低CPB患者外周血CR3的表达水平和PMN内cAMP、cGMP的浓度,从而减轻CPB时全身炎症反应.
목적 평개록알동대체외순배판막치환술환자외주혈표면점부분자CR3표체수평화중성립세포(PMN)내염증개질cAMP농도적영향.방법 60례체외순배(CPB)하판막치환술환자수궤평균분성4조,분별위대조조、록알동Ⅰ조、록알동Ⅱ조화록알동Ⅲ조(n=15),체외순배전10 min경경내정맥분별급이생리염수(대조조)、록알동Ⅰ조(0.1 mg/kg)、록알동Ⅱ조(0.5 mg/kg)화록알동Ⅲ조(1.0 mg/kg),병분별재마취유도전즉각(T1)、체외순배개시전10 min(T2)、체외순배결속즉각(T3)、체외순배결속후24 h(T4)불동시점종경내정맥채혈,용류식세포의검측CB3표체정황,고효액상색보법측정cAMP화cGMP농도,관찰환자심솔、혈압적변화화혈관활성약물적사용정황.결과 T1,T2시점각조측량지표차이무통계학의의(P>0.05).T3,T4시점,여대조조상비,각록알동시험조환자외주혈CR3표체균강저(P<0.05),기중록알동Ⅱ조화록알동Ⅲ조수평경저우록알동Ⅰ조(P<0.05).T3,T4시점,여대조조화록알동Ⅰ조상비,록알동Ⅱ화록알동Ⅲ조환자외주혈PMN내cAMP농도균증고(P<0.05).T3시점,여대조조화록알동Ⅰ조상비,록알동Ⅱ조화록알동Ⅲ조환자외주혈PMN내cGMP농도균강저(P<0.05).T4시점,여대조조화록알동Ⅰ조환자상비,록알동Ⅱ화록알동Ⅲ조환자적평균동맥압(MAP)승고(P<0.05).록알동Ⅲ조비기타각조술후사용경소적혈관활성약(P<0.05).결론 록알동가일정정도지강저CPB환자외주혈CR3적표체수평화PMN내cAMP、cGMP적농도,종이감경CPB시전신염증반응.
Objective To evaluation the efficacy of ketamine on the expression of adhension molecular CR3and intracellular cAMP, cGMP in neutrephils in patients associated with cardiopulmonary bypass (CPB), as well as the cardiovascular function of the CPB patients. Method Sixty patients operated on with prosthetic valve replace-rnent under CPB were randomly divided into 4 groups: placebo, ketamine 0.1 mg/kg ( ketamine Ⅰ) ,ketamine 0.5 mg/kg ( ketamine Ⅱ) ,ketamine 1 mg/kg( ketamine Ⅲ). Each group included 15 eases. Venous blood sam-pies were obtained during anesthesia induction (T1), 10 min before CPB (T2), end of CPB (T3) and 24 hoursafter operation (T4). The expression of CR3 was measured by Flow cytometry and the concentration of cAMP/cGMP by HPLC. Results Ketamine with various dosages decreased the expression of CR3 at the T3 and T4 inpatients of ketamine groups compared with patients of placebo group (P<0.05). The dosages of ketamine Ⅱgroup and ketamine Ⅲ group had more significant effect than that of ketamine Ⅰ group. The dosages of ketamineⅡ and ketamine Ⅲ group increased the intracellular cAMP at the T3 and T4 compared with ketamine Ⅰ groupand placebo (p<0.05), respectively. However,cGMP was lower in ketamine Ⅱ and ketamine Ⅲ group thanthat in ketamine Ⅰ group and placebo (P<0.05) at the T3.Morever,the mean arterial blood pressure was higherin ketamine Ⅱ and ketamine Ⅲ group at T4. Only the patients of ketamine Ⅲ group required less inotropic drugsafter operation. Conclusions Ketamine can reduce the expression of adhhension molecular CB3 and intracellularcAMP, cGMP in neutrophils from patients associated with CPB.