异丙酚麻醉下烧伤手术患者血小板聚集功能的变化

Effect of propofol on platelet function in massive burn operation patients

目的观察异丙酚静脉麻醉对大面积烧伤手术患者血小板聚集功能的影响。方法55例大面积烧伤手术患者随机分为异丙酚组(P组)和氯胺酮组(K组),分别于麻醉诱导前、手术开始30min、1、2h以及手术结束停药后1h采血,比浊法测量血小板最大聚集率,双波长荧光比值法测量血小板内游离Ca2+浓度([Ca2+]i)。结果(1)两组烧伤患者的血小板最大聚集率、血小板静息[Ca2+]i均明显高于正常对照组(C组)。与C组相比,P组和K组的血液明显处于高凝状态。(2)与术前相比,P组术中及术后血小板最大聚集率、血小板静息[Ca2+]i显著降低。(3)与术前相比,K组术中及术后血小板最大聚集率、血小板静息[Ca2+]i均进一步升高,明显高于诱导前。结论(1)烧伤后血小板被激活,血小板内游离钙浓度([Ca2+]i)和聚集性均升高,血液处于高凝状态;(2)异丙酚通过降低血小板内游离钙水平,抑制血小板聚集作用,可稳定凝血功能状态。

Objective To investigate the effect of intravenous infusion of propofol on platelet function after massive burn injury. Methods Fifty-five massive burn patients were randomly classified into 2 groups, namely propofol group（P） and ketamine group （K）. Platelet aggregation and the changes of intracellular calcium concentration were measured at the following time point： pre-induction of anesthesia, 0.5h, 1h and 2h after skin incision and lh after operation. Results （1）As compared with that of coutrol group, there was significant difference in aggregation rate and intracellular free calcium of platelet of P group and K group after burn injury. （2）In P group the aggregation rate and intracellular free calcium of platelet were obviously lower than that of pre-induction of anesthesia. （3）In K group the aggregation rate and intracellular free calcium of platelet during operation and at the end of operation were higher than that of pre-induction of anesthesia. Conclusion （1）The ability of platelet aggregation induced by activated platelet are increased after burn injury. （2）The use of propofol during massive burn operation inhibit platelet aggregation by suppressed influx of calcium and partially reduce the degree of platelet activation.