小剂量芬太尼与氯胺酮联合用于PCIA的临床体会

目的观察微量小剂量芬太尼与氯胺酮联合于术后病人自控静脉镇痛(PCIA)的效果及不良反应,并与较大剂量芬太尼PCIA进行比较。方法选择ASAⅠ~Ⅱ级、年龄(45.8±11.2)岁、全麻下行腹部手术病人80例,随机分为4组:Ⅰ组为芬太尼2.0 mg,Ⅱ组为芬太尼1.5 mg+氯胺酮250 mg,Ⅲ组为芬太尼1.5mg+氯胺酮500 mg,Ⅳ组为芬太尼1.5 mg+氯胺酮750 mg;各组均加5 mg氟哌啶,然后加生理盐水至100mL。PCIA持续输注速度为24μL.kg-1.h-1。记录术后4、24、48及72 h的VSA评分、镇静评分、呼吸次数及SpO2变化情况。结果Ⅱ组VAS评分4个时点均明显高于Ⅰ组(P<0.05或P<0.01)。Ⅰ组出现睡眠的病人也较多。结论适量小剂量芬太尼与氯胺酮联合用于术后PICA,能明显改善病人嗜睡的状况,镇痛效果也较理想,从而减少了术后嗜睡和呼吸抑制的状况。     

Dissociative anesthesia and striatal neuronal electrophysiology.

Compared with results obtained in locally anesthetized, paralyzed rats, the dissociative anesthetic ketamine did not alter either the number of spontaneously active striatal neurons or the basal firing rate of striatal neurons; 90% of these cells exhibited the type I striatal neuron waveform. Chloral hydrate anesthesia suppressed both the occurrence and the firing rate of spontaneously active type I cells, but did not alter the activity of type II striatal neurons. Cortical stimulation preferentially activated type II cells in paralyzed rats and in chloral hydrate-anesthetized rats. Thus, under dissociative anesthesia it is possible to study spontaneously active type I striatal neurons. However, a method of activation such as cortical stimulation is necessary to study type II striatal neurons.     

氯胺酮对脂多糖诱导下人脐静脉内皮细胞活化的影响

目的 观察氯胺酮和N-甲基-D-天门冬氨酸(NMDA)受体非竞争性拮抗剂MK-801对脂多糖(LPS)刺激下人脐静脉内皮细胞(HUVECs)胞间粘附分子-1(ICAM-1)表达及核因子-kappa B(NF-kB)易位表达的影响。方法 采用Jaffe方法培养的HUVECs随机分为10组:对照组(C组,RPMI-1640),LPS组(L组,LPS1μg/ml),氯胺酮组(K组,依浓度不同分为KⅠ、KⅡ、KⅢ、KⅣ亚组,即氯胺酮12.5、25.0、100、300μmol/L LPS1μg/ml),MK-801组(M组,依浓度不同分为MⅠ、MⅡ、MⅢ、MⅣ亚组,即MK-801 1.25、2.50、10、30μmol/L LPS1μg/ml)。在37℃、5％CO_2中孵育18h后,用流式细胞仪检测ICAM-1的表达阳性率。NF-kB易位表达的测定分组处理同上,在LPS1μg/ml刺激2h后,用免疫组化(SP)方法测定内皮细胞中NF-kB p65亚基的表达。结果 KⅡ、KⅢ、KⅣ亚组可抑制LPS作用下HUVECs表面ICAM-1的表达和细胞内部NF-kB的易位表达(P<0.05),且两者的变化呈正相关(r=0.985,P<0.01)。M组各亚组对LPS作用后HUVECs表面ICAM-1的表达和NF-kB的易位表达无明显影响(P>0.05)。结论 氯胺酮对炎症反应中内皮细胞的活化具有抑制作用,但并非通过NMDA受体途径。     

氯胺酮对体外培养大鼠神经干细胞增殖与凋亡的影响

目的探讨氯胺酮对体外培养夫鼠神经干细胞(NSC)增殖与凋亡的影响。方法采用无血清培养和单细胞克隆技术,在大鼠海马分离培养具有单细胞克隆能力的细胞群,采用免疫荧光细胞化学技术证实为NSC。将NSC以5×10~4/孔接种于96孔培养板中,分别加入浓度为0(未加氯胺酮)、5、10、20、50、100、200、500、1000 mmol·L~(-1)氯胺酮,每个浓度5孔。采用四甲基偶氮唑蓝比色法检测NSC光密度(OD),并计算生长抑制率(RI)。采用流式细胞仪测定氯胺酮浓度为0、10、100、500、1000 mmol·L~(-1)时NSC凋亡率。结果与氯胺酮浓度0时比较,200、500、1000 mmol/L氯胺酮可降低NSC OD,升高RI,10、100、500、1000 mmol·L~(-1)氯胺酮可升高NSC凋亡率(P＜0．05或0．01)。结论氯胺酮对体外培养大鼠NSC增殖有抑制作用,并能诱导NSC凋亡,且该作用与氯胺酮浓度有关     

氯胺酮复合不同药物用于硬膜外术后镇痛的观察

目的 :探讨氯胺酮复合不同药物用于硬膜外术后镇痛的效果 ,为硬膜外应用氯胺酮合剂镇痛提供依据。方法 :择期行下腹部或下肢手术病人 75例 ,随机分成 5组 :Ⅰ组氯胺酮 30mg ;Ⅱ组氯胺酮 30mg加罗哌卡因 15mg ;Ⅲ组氯胺酮 30mg加咪唑安定 3mg ;Ⅳ组氯胺酮 30mg加吗啡 2mg ;Ⅴ组吗啡 2mg ,镇痛剂均用生理盐水稀释至 5ml。观察镇痛效果 ,镇痛持续时间和不良反应。结果 :Ⅰ组术后完全无痛者占 5 3 33% ,明显少于Ⅳ、Ⅴ组的 86 6 7% (P <0 0 5 ) ;镇痛持续时间 7 13h ,明显短于其他 4组 (P <0 0 5 )。Ⅳ、Ⅴ组恶心、呕吐、皮肤瘙痒发生率明显高于其他 3组 ,Ⅰ组有 1例出现谵妄。结论 :硬膜外腔注入氯胺酮有镇痛作用 ,加用罗哌卡因、咪唑安定等可增强其镇痛效果 ,延长镇痛时间     

一氧化氮在氯胺酮麻醉机制中的作用

目的：了解一氧化氮（ＮＯ）与氯胺酮麻醉作用间的关系。方法：６０只雄性昆明鼠分成４组，Ⅰ组氯胺酮１００ｍｇ／ｋｇ腹腔内注射，Ⅱ组连续３天腹腔内注射Ｎ－硝基左旋精氨酸甲酯（Ｌ－ＮＡＭＥ）５０ｍｇ／ｋｇ后，腹腔内注射氯胺酮１００ｍｇ／ｋｇ，Ⅲ组连续３天腹腔内注射左旋精氨酸３００ｍｇ／ｋｇ后，腹腔内注射氯胺酮１００ｍｇ／ｋｇ，Ⅳ组腹腔内注射氯胺酮１００ｍｇ／ｋｇ后，腹腔１小时内持续给予Ｓ－亚硝酰－Ｎ－乙酰青霉胺（ＳＮＡＰ）３０ｍｇ／ｋｇ。观察各组动物翻正反射丧失和抑制持续时间。结果：各组翻正反射丧失时间无明显差异，为１．３９～２．３０分钟。翻正反射丧失持续时间Ⅰ组４７．７１±５．１７分，Ⅱ组４７．８４±７．９９分，Ⅲ组和Ⅳ组明显比Ⅰ、Ⅱ组短，分别为３１．１４±２．４４和３２．７５±８．１４分（Ｐ＜０．０１）。结论：改变ＮＯ的生成量将影响着氯胺酮引起的小鼠翻正反射抑制的持续时间，ＮＯ在氯胺酮麻醉分子机制中起作用。     

氯胺酮对离体大鼠心室肌细胞内向整流钾电流的影响

目的观察氯胺酮对离体大鼠心室肌细胞内向整流钾电流(I_(k1))的影响。方法酶解法分离大鼠心室肌细胞,采用全细胞膜片钳技术记录 I_(k1),观察100μmol/L 氯胺酮在不同钳制电压下以及不同浓度(50～5000μmol/L)氯胺酮在-120mV 钳制电压下对大鼠心室肌细胞 I_(k1)的影响。结果 100 μmol/L 氯胺酮抑制 I_(k1),但不改变 I_(k1)翻转电压以及电流-电压曲线的形状；I_(k1)灌流液冲洗后,I_(k1)能够完全恢复。保持电压-40mV、钳制电压-120mV 下5～5000μmol/L 氯胺酮呈浓度依赖性抑制 I_(k1)其 IC_(50)为(162.3±8.4)μmol/L。结论氯胺酮呈浓度依赖性抑制大鼠心室肌细胞 I_(k1),可能延长动作电位时程导致心率变慢。     

The effect of racemic ketamine on the large conductance Ca-activated potassium (BK) channels in GH3 cells

Recently, inhalation anesthetics have been reported to block BK channels in adrenal chromaffin cells. To determine if BK block was characteristic only of inhalation anesthetics or was also a property of other general anesthetics we examined the effects of ketamine, an intravenous general anesthetic which is structurally different than inhalation anesthetics. Cell-attached and excised patch single channel and standard whole cell recording techniques were used to examine the effect of racemic ketamine on the BK channel activity in GH₃ cells. When solutions containing 150 mM KCl are used in both the pipette and bath, the BK channels are characterized as a voltage-dependent channel with a unit conductance of 150–300 pS. Racemic ketamine (at clinically relevant concentrations; 2–500 μM) selectively blocked BK channels in a dose-dependent, reversible manner as evidenced by decreases in NP_o (number of channels × open probability). This decrease was due to both a decrease in mean open time and an increase in the mean closed time but without a decrease in single-channel current amplitude. Ketamine shifts the P_o vs voltage curve to higher potentials without a change in the slope of the voltage dependence. Ketamine also shifts the P_o vs [Ca⁺²] relationship to higher Ca⁺² concentrations. The IC₅₀ for the single-channel block by ketamine is 20.3 ± 15.9 μM. In an effort to confirm that the effect of ketamine was predominantly due to a block of the BK channels, standard whole cell techniques were utilized. As with the single-channel experiments, ketamine (2–500 μM) produced a dose-dependent, voltage-independent and reversible decrease in outward current with an IC₅₀ of 23.7 ± 11.5 μM. Addition of 100 μM ketamine to cells pretreated with the BK channel blocker, charybdotoxin (ChTX), did not result in a further decrease in outward current. These results demonstrate a selective effect of ketamine at clinically relevant concentrations which is consistent with results reported for inhalation anesthetics.     

丙泊酚、氯胺酮全凭静脉麻醉应用于烧伤病人的临床研究

目的:研究微量注射泵输注丙泊酚和氯胺酮全凭静脉麻醉在烧伤患者切痂植皮手术中的临床效果。方法:选择期手术患者,随机分为丙泊酚、氯胺酮组(P·K组)和咪达唑仑、氯胺酮组(M·K组)。P·K组术前10min首次静注丙泊酚2mg·kg和氯胺酮2mg·kg。M·K组术前10min首次静注咪达唑仑0 2mg·kg、氯胺酮2mg·kg ,随后两组以微量注射泵输注控制在P·K组丙泊酚6 6 . 6 6 μg·kg-1·min-1和氯胺酮4 1 .6 6 μg·Kg-1·min-1。记录注药后5、10min、切痂、取皮、植皮及停药后5、10min各时段无创血压(MAP)心率(HR)脉搏氧饱和度(SpO2 )及两组氯胺酮用药量变化。结果:P·K组氯胺酮用药量比M·K组少,P·K组MAP和HR无明显变化(P >0 . 0 5 ) ,M·K组MAP、HR均较麻醉前升高(P <0 . 0 1) ,两组SpO2 于诱导注药后均有一过性下降,数分钟恢复正常,两组比较差异无显著意义(P >0 . 0 5 )。结论:微量注射泵输注丙泊酚和氯胺酮全凭静脉麻醉安全可行,副作用小,可控性强,适用于烧伤患者切痂植皮手术。     

异丙酚及氯胺酮靶控输注全静脉麻醉临床应用

目的　研究异丙酚复合不同镇痛剂量氯胺酮靶控输注全静脉麻醉临床应用的可行性及对血流动力学、麻醉恢复的影响。方法　择期手术患者 80例 ,分别采用异丙酚 (P组 ,n =16)及复合氯胺酮血药浓度 0 2 0mg/L(PK1组 ,n =16) ,0 40mg/L(PK2 组 ,n =16) ,0 60mg/L(PK3 组 ,n =16)和 0 80mg/L(PK4组 ,n =16)全静脉麻醉 ,采用微机控制Graseby 3 5 0 0输液泵靶控输注异丙酚或氯胺酮 ,连接Aspect-A10 0 0型脑电监护仪监测脑电变化 ,观察两组患者血流动力学改变及麻醉恢复情况。结果　单用异丙酚患者随着异丙酚血药浓度升高脑电双频指数 (BIS)值降低 ,呈明显负相关 (P <0 0 5 ) ,氯胺酮血药浓度从 0 2 0mg/L增至 0 80mg/L ,BIS值无明显变化 (P >0 0 5 )。与P组相比 ,PK1,PK2 ,PK3 ,PK4组异丙酚用量减少约 15 %～ 40 % ,PK4组停药至睁眼时间明显延长 ,其余各组无明显差异 (P >0 0 5 )。术中P ,PK1组收缩压、舒张压升高 ,PK2 ,PK3 ,PK4组无明显改变。术后无躁动、不良回忆等并发症。结论　异丙酚复合镇痛剂量的氯胺酮 (0 40～ 0 60mg/L)靶控输注全静脉麻醉具有血流动力学稳定、减少异丙酚用量、无明显术后并发症等优点。