小剂量氯胺酮预先镇痛对上腹部手术患者细胞因子反应的影响

目的:探讨小剂量氯胺酮预先镇痛是否会对上腹部手术所致细胞因子反应产生影响。方法:30例ASAⅠ-Ⅱ级择期上腹部手术患者,随机分为3组,每组10人。在静脉麻醉药物诱导气管插管后,A组为对照组;于切皮前5 min给予生理盐水5 ml。B组为氯胺酮一组,于切皮前5 min给予氯胺酮0.2 mg/kg。C组为氯胺酮二组,患者于切皮前5 min给予氯胺酮0.6 mg/kg。分别于麻醉诱导前及手术结束后抽取静脉血分离血清,用放免法检测肿瘤坏死因子-α(TNFα-)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)。结果:3组的TNF-α、IL-8水平在麻醉前及手术后差别无显著意义(P>0.05),A组的IL-6水平在手术后明显升高(P<0.05),B、C组IL-6水平在手术后与麻醉前比较无明显变化(P>0.05);但与A组的IL-6手术后水平相比有显著性差异(P<0.05)。结论:0.2-0.6 mg/kg的氯胺酮预先给药可抑制上腹部手术时细胞因子IL-6的升高。

Effect of Preemptive Analgesia by Intravenous Small-dose Ketamine on Cytokine Response to Upper Abdominal Surgery

Objective: To study the effect of preemptive analgesia by intravenous small-dose ketamine on cytokine response to upper abdominal surgery.Methods: Thirty patients(ASAⅠ-Ⅱ) undergoing selective upper abdominal surgery were allocated randomly to three groups.After anesthesia,group A was administrated with 5 ml 0.9% natrium chloride(NaCl) at 5 min before skin incision.Group B was administrated with ketamine 0.2 mg/kg at 5 min before skin incision.Group C was administrated with ketamine 0.6 mg/kg at 5 min before skin incision.Blood samples for the measurements of serum tumor necrosis factor(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)were obtained at two time points:before anesthesia and immediately after operation.TNF-α,IL-6 and IL-8 levels were measured by radioimmunoassay.Results: Compared with those before anesthesia,changes of TNF-α and IL-8 were not significant among the three groups(both P>(0.05).) IL-6 levels increased significantly(P<0.05) in group A after operation,while in group B and C showed no changes(both P>0.05).Conclusion: The treatment of 0.2-0.6 mg/kg Ketamine preemptive analgesia could prevent IL-6 from levels increasing in response to abdominal surgery.