小剂量氯胺酮麻醉对感染性休克患者C-反应蛋白的影响

Impact of low dose of ketamine anesthesia on C-reactive protein of septic shock patients

目的探讨小剂量氯胺酮麻醉对感染性休克患者C-反应蛋白(CRP)的影响,为临床治疗感染性休克患者提供理论依据。方法选取2012年2月-2015年2月于医院接受治疗感染性休克的患者62例作为研究对象,按麻醉方式不同将患者随机分为对照组和试验组,每组各31例;对照组患者采用芬太尼、咪达唑仑及维库溴铵进行全身麻醉,而试验组患者采用氯胺酮进行麻醉;分别于手术麻醉前30min、术后1、24、48h采集患者动脉血样,检测血液中CRP的浓度,观察患者手术过程前、后的血压、血氧饱和度及心率;采用SPSS19.0软件进行统计分析。结果两组患者术后24、48h的CRP水平明显低于同组的手术麻醉前30min、术后1h,差异有统计学意义(P<0.05);试验组患者在术后24、48h的CRP水平明显低于对照组患者,差异有统计学意义(P<0.05);两组患者术后的各项指标均好于手术前,血压升高至正常水平,心率降低,血氧饱和度维持在90.0%以上。结论氯胺酮作为常用的麻醉药物,小剂量使用可有效抑制患者CRP的升高,对感染性休克患者的安全性提供有利保障,在临床应用上值得借鉴。

OBJECTIVE To explore the impact of low dose ketamine anesthesia on C-reactive protein（CRP）of septic shock patients so as to provide theoretical basis for clinical treatment of the patients with septic shock.METHODS A total of 62 patients with septic shock who were treated in the hospital from Feb 2012 to Feb 2015 were recruited as the study objects and randomly divided into the control group and the experimental group according to the anesthesia method,with 31 cases in each.The control group was treated with general anesthesia with fentanyl,midazolam,and vecuronium;while the experimental group was given anesthesia with ketamine.The arterial blood samples were respectively collected at 30 min before the anesthesia,1,24,and 48 hours after the anesthesia;the level of blood CRP was determined,the blood pressure,oxygen saturation,and heart rate were observed before and after the surgery,and the statistical analysis was performed with the use of SPSS19.0software.RESULTS The CRP level of the two groups of patients was significantly lower at 24 or 28hours after the surgery than at 30 min before the anesthesia or 1hour after the surgery,and there was significant difference（P〈0.05）.The CRP level of the experimental group was significantly lower than that of the control group at 24 or 48hours after the surgery,and there was significant difference（P〈0.05）.The indicators of the two groups of patients were better after the surgery than before the surgery,the elevated blood pressure returned to normal,the heart rate was reduced,and the blood oxygen saturation maintained at more than 90.0%.CONCLUSIONAs a commonly used anesthesia drug,the low dose of ketamine can effectively inhibit the elevation of CRP level and guarantee the safety of the septic shock patients,and it is worthy to be promoted in the hospital.