氯胺酮对法洛四联症手术患者血浆HSP70表达的影响

Influence of Ketamine on the Expression of Plasma Heat-shock Protein 70 in Patients Undergoing Open Heart Surgery of Tetralogy of Fallot

目的观察氯胺酮对法洛四联症矫治术患者血浆热休克蛋白70（heat shock proteins 70,HSP70）表达的影响。方法 20例择期行法洛四联症矫治术的患者,ASAⅢ-Ⅳ级,随机分为氯胺酮组（K组）和对照组（C组）,每组各10例。K组于麻醉诱导和转流开始时静脉注射氯胺酮2 mg/kg,C组予等容量的生理盐水。分别于麻醉诱导前即刻（T0）、CPB开始后30 min（T1）、主动脉开放后30 min（T2）、停机后1 h（T3）采桡动脉血5 ml,以酶联免疫吸附法（ELISA）测定血浆中的HSP70浓度。结果组内与T0时比较,两组患者T1、T2、T3时HSP70水平均升高（P〈0.05或P〈0.01）;组间比较,K组在T1、T2、T3时血浆HSP70水平均高于C组（P〈0.05或P〈0.01）。结论氯胺酮可增加血浆HSP70水平,改善心肌缺血再灌注损伤,提高TOF矫治术的麻醉质量。

Objective To observe the influence of ketamine on the expression of plasma heat-shock protein 70（HSP70） in patients performed open heart surgery of tetralogy of Fallot（TOF）.Methods 20 TOF patients scheduled for selective open heart surgery,with ASA Ⅲ to Ⅳ,were randomized into ketamine group（group K） and Control group（group C）.When anesthesia induction and cardiopulmonary bypass（CPB） performed,ketamine 2 mg/kg was injected to group K,whereas equivalent normal saline was supplied to group C.The level of HSP 70 were detected by enzyme-linked immunoassay（ELISA） before the anesthesia（T0）,30 minutes after the beginning of CPB（T1）,30 minutes after release of the aorta clamping（T2） and 1 hour after surgery（T3）.Results Compared with the level of T0,the level of HSP70 increased significantly at the time points of T1,T2 and T3 in both two groups（P〈0.05）.At the time points of T1,T2 and T3,the level of HSP70 was obviously higher in group K than that in group C（P〈0.05）.Conclusion Ketamine can increase the level of HSP70,protect myocardial reperfusion injury,and improve anesthesia quality of TOF surgery.