Timm Claudia, Linstedt U, Weiss T, Zenz M, Maier C
Klinik für Anaesthesiologie, Intensiv-, Palliativ- und Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-Universität Bochum, Bürkle-de-la Camp Platz 1, 44789, Bochum.
Anaesthesist. 2008 Apr;57(4):338-46. doi: 10.1007/s00101-008-1331-0.
In analgetic dosages ketamine has stimulatory effects on the cardiovascular system, which limits its use in patients with heart disease. The aim of this study was to clarify whether low-dose S(+)-ketamine used to prevent chronic pain similarly stimulates the cardiovascular system and to determine the impact of propofol dosage on this effect.
A total of 80 patients undergoing surgery under spinal or epidural anesthesia were randomly assigned to receive double-blinded S(+)-ketamine [0.25 mg/kg body weight (BW) bolus followed by infusion of 0.06 mg/kg BW/h] or placebo in the presence of continuous propofol infusion (2-5 mg/kg BW/h). The heart rate, blood pressure and calculated rate-pressure product (RPP) were monitored.
Following the S(+)-ketamine bolus, the heart rate, blood pressure and RPP increased significantly. In the presence of a propofol dosage >3 mg/kg BW/h the stimulatory cardiovascular effect could no longer be observed.
Even low-dose S(+)-ketamine has a stimulatory effect on the cardiovascular system. This stimulatory effect is nullified in the presence of a continuous propofol infusion at a dosage of more than 3 mg/kg BW/h.
在镇痛剂量下，氯胺酮对心血管系统有刺激作用，这限制了其在心脏病患者中的应用。本研究的目的是阐明用于预防慢性疼痛的低剂量S(+)-氯胺酮是否同样会刺激心血管系统，并确定丙泊酚剂量对该效应的影响。
总共80例接受脊髓或硬膜外麻醉的手术患者被随机分配，在持续输注丙泊酚（2-5mg/kg体重/小时）的情况下，接受双盲S(+)-氯胺酮[0.25mg/kg体重静脉推注，随后以0.06mg/kg体重/小时输注]或安慰剂。监测心率、血压和计算得出的率压乘积（RPP）。
给予S(+)-氯胺酮静脉推注后，心率、血压和RPP显著升高。在丙泊酚剂量>3mg/kg体重/小时的情况下，不再观察到对心血管系统的刺激作用。
即使是低剂量的S(+)-氯胺酮也对心血管系统有刺激作用。在持续输注剂量超过3mg/kg体重/小时的丙泊酚时，这种刺激作用会消失。
