氯胺酮、异丙酚对全膝关节置换术病人血MDA和SOD的影响

Effects of ketamine and propofol on blood MDA and SOD in patients undergoing total knee replacement

目的:探讨氯胺酮、异丙酚对肢体缺血再灌注损伤的保护作用。方法:选择36例择期硬膜外麻醉下行全膝关节置换术的病人,随机分为3组:对照组(C组),氯胺酮组(K组)和异丙酚组(P组)。分别于上止血带前(T1),止血带充气后30分钟(T2),松止血带后5分钟(T3)3个时间抽取静脉血测定血浆丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性。结果:3组病人间一般情况、T1时点MDA及SOD值比较无统计学意义(P>0.05);在缺血期(T2)3组病人血MDA值得显著升高(P<0.05);再灌注期(T3)3组病人MDA进一步升高,SOD活性则较T1时点显著降低(P<0.01),K组和P组MDA值低于C组,而SOD值均明显高于C组(P<0.05或P<0.01),且P组MDA值低于K组,SOD值高于K组(P<0.05)。结论:氯胺酮和异丙酚可抑制肢体缺血再灌注引起的脂质过氧化反应,对肢体氧化损伤可能有一定的保护作用,异丙酚的作用优于氯胺酮。

Objective：To investigate the protective effect of ketamine and propefol on limb ischemia-repedusion induced by injury. Methods：Thirty-six ASA I - II patients undergoing selective total knee replacement with tourniquet were randomly divided into three groups,control group／propofol group and ketamine group.After spinalanesthesia and IV administration of meperidine and droperidol mixture,ketamine 0.5 mg/kg was injected followed by infusion at a rate of 0.5 mg/kg, h） and propefol 0.5 mg/kg followed by an infusion of 2 mg/kg-h） respectively in ketamine and propofol group.Blood samples were obtained from venous blood before ketamine and propofol infusion,at 30 min of tourniquet ischemia,and at 5 min after tourniquet deflation for MDA and SOD measurements.Results：Plasma MDA levels increased significantly and SOD concentration wered obviously decreased after tourniquet deflation.In ketamine and propefol group,MDA levels were significantly less and SOD were higher than in control group after repedusion （P〈0.05）.Compared with ketamine group,MDA level was less and SOD was higher in propofol group （P〈0.05）.Conclusion：Ketamine and propofol sedation attenuate Lipid pemxidation markers in total knee replacement with tourniquet appLication.The protctive effect of propefol on oxidative damage is superior to ketamine.