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Effect of low-dose ketamine on brain injury in patients undergoing open-heart surgery with cardiopulmonary bypass
Author(s): 
Pages: 134-137
Year: Issue:  3
Journal: Acta Academiae Medicinae Shandong

Keyword:  KetamineCardiopulmonary bypassBrain injury;
Abstract: 目的观察小剂量氯胺酮对心内直视手术患者心肺转流(CPB)后脑损伤是否具有减轻作用并探讨其机制。方法40例择期心内直视手术患者,随机分为氯胺酮组(n=20)和对照组(n=20)。氯胺酮组于麻醉诱导后静脉注射氯胺酮0.5mg/kg,对照组给予等体积的生理盐水。分别于麻醉诱导前(T1),CPB前(T2),CPB后30min(T3),CPB结束时(T4),CPB结束后4h(T5),CPB结束后24h(T6),采取颈内静脉血,用酶联免疫法(ELLSA)检测血浆S100β蛋白的含量,放射免疫法测定肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)的浓度。记录术前1d和术后3d简易智能量表(MMSE)评分并进行脑功能临床评估。结果两组患者T3,T4,T5S100β蛋白水平均高于T1,与对照组相比,氯胺酮组在T3,T4,T5血浆S100β蛋白含量显著降低(P<0.05)。两组患者T3,T4,T5,T6TNF-α、IL-6水平明显高于T1,与对照组相比,氯胺酮组在T3,T4,T5血浆TNF-α、IL-6含量显著降低(P<0.05)。氯胺酮组术后3dMMSE评分高于对照组,认知功能下降的发生率低于对照组(P<0.05)。结论小剂量氯胺酮能减轻心内直视手术患者心肺转流后的脑损伤,抑制心肺转流诱导的过度炎症反应可能是其部分机制。
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