摘要
目的 评价艾司氯胺酮对肝移植术患者围术期心肌损伤的影响.方法 本研究为前瞻性随机对照研究.选取2023年5月至10月在本院拟行全身麻醉下肝移植术患者60例,性别不限,年龄18～64岁,ASA分级Ⅲ或Ⅳ级,心功能分级Ⅰ-Ⅲ级.采用随机数字表法将其分为2组(n=30):艾司氯胺酮组(S组)和对照组(C组).S组于麻醉诱导后静脉注射艾司氯胺酮0.5mg/kg,随后以0.5 mg·kg-1·h-1的速率持续静脉泵注至手术结束.C组以等容量生理盐水替代.于麻醉诱导后(T0)、无肝期30 min(T1)、新肝期30 min(T2)、关腹(T3)、术后24 h(T4)及术后72 h(T5)时采集中心静脉血样,采用ELISA法检测血清高敏肌钙蛋白Ⅰ(hs-cTnⅠ)、肌酸激酶同工酶(CK-MB)、N末端B型利钠肽前体(NT-proBNP)、TNF-α、IL-6、IL-10及高迁移率族蛋白B1(HMGB1)浓度.记录术中和术后24 h内心脏不良事件发生情况、术后机械通气时间、ICU停留时间及术后住院时间.结果 与C组比较,S组T2-5时血清hs-cTnⅠ、CK-MB、NT-proBNP、TNF-α和IL-6浓度降低,T2-4时HMGB1浓度降低,T2-5时血清IL-10浓度升高,心肌缺血发生率降低,机械通气时间缩短(P＜0.05),ICU停留时间以及术后住院时间差异无统计学意义(P＞0.05).结论 术中应用艾司氯胺酮可抑制肝移植术患者炎症反应,减轻患者围术期心肌损伤.
Abstract
Objective To evaluate the effect of s-ketamine on perioperative myocardial injury in patients undergoing liver transplantation.Methods This was a prospective randomized controlled study.Sixty American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ patients,aged 18-64 yr,with New York Heart Association class Ⅰ-Ⅲ,undergoing elective liver transplantation with general anesthe-sia in our hospital from May to October 2023,were divided into 2 groups(n=30 each)using a random number table method:s-ketamine group(group S)and control group(group C).In group S,s-ketamine was intravenously injected at a dose of 0.5 mg/kg after induction of anesthesia,followed by an infusion of 0.5 mg·kg-1·h-1 until the end of surgery.The equal volume of normal saline was given instead in group C.Central venous blood samples were collected after induction of anesthesia(T0),at 30 min of anhepatic phase(T1),30 min of neopepatic phase(T2),abdominal closure(T3),24 h after operation(T4)and 72 h after operation(T5)for determination of the concentrations of serum high-sensitivity cardiac troponin I,creatine kinase-MB isoenzyme,N-terminal pro-B-type natriuretic peptide,tumor necrosis factor-α,interleu-kin-6(IL-6),IL-10 and high-mobility group protein B1 by enzyme-linked immunosorbent assay.The occur-rence of adverse cardiac events during surgery and within 24 h after surgery,postoperative mechanical ventila-tion time,time of intensive care unit stay,and postoperative length of hospital stay were recorded.Results Compared with group C,the concentrations of serum high-sensitivity cardiac troponin I,creatine kinase-MB isoenzyme,N-terminal pro-B-type natriuretic peptide,tumor necrosis factor-α and IL-6 at T2-5 and high-mobil-ity group protein B1 at T2-4 were significantly decreased,the concentrations of serum IL-10 were increased at T2.5,the incidence of myocardial ischemia was decreased,the mechanical ventilation time was shortened(P＜0.05),and no significant change was found in the time of intensive care unit stay and postoperative length of hospital stay in S group(P＞0.05).Conclusions Intraoperative usage of s-ketamine can inhibit the inflam-matory responses and reduce perioperative myocardial injury in the patients undergoing liver transplantation.
基金项目
天津市科技计划多元基金面上项目(21JCYBJC01190)
国家自然科学基金面上项目(82072219)
天津市医学重点学科项目(TJYXZDXK-045A)
NETL
NSTL
万方数据