[硬膜外间隙低剂量S-(+)-氯胺酮的交感神经活动]

Mihaljevic Slobodan, Mihaljevic Ljiljana, Cacic Marko

Hospital de Clínicas de Zagreb, Faculdade de Medicina da Universidade de Zagreb, Klinički Bolnički Centar, Zagreb, Croácia.

Braz J Anesthesiol. 2014 Jul-Aug;64(4):227-35. doi: 10.1016/j.bjan.2013.03.017. Epub 2014 Feb 26.

BACKGROUND AND OBJECTIVES

S-(+)-ketamine is an intravenous anaesthetic and sympathomimetic with properties of local anaesthetic. It has an effect of an analgetic and local anaesthetic when administered epidurally, but there are no data whether low doses of S-(+)-ketamine have sympathomimetic effects. The aim of this study was to determine whether low doses of S-(+)-ketamine, given epidurally together with local anaesthetic, have any effect on sympathetic nervous system, both systemic and below the level of anaesthetic block.

METHODS

The study was conducted on two groups of patients to whom epidural anaesthesia was administered to. Local anaesthesia (0.5% bupivacaine) was given to one group (control group) while local anaesthesia and S-(+)-ketamine were given to other group. Age, height, weight, systolic, diastolic and mean arterial blood pressure were measured. Non-competitive enzyme immunochemistry method (Cat Combi ELISA) was used to determine the concentrations of catecholamines (adrenaline and noradrenaline). Immunoenzymometric determination with luminescent substrate on a machine called Vitros Eci was used to determine the concentration of cortisol. Pulse transit time was measured using photoplethysmography. Mann-Whitney U-test, Wilcoxon test and Friedman ANOVA were the statistical tests. Blood pressure, pulse, adrenaline, noradrenaline and cortisol concentrations were measured in order to estimate systemic sympathetic effects.

RESULTS

40 patients in the control group were given 0.5% bupivacaine and 40 patients in the test group were given 0.5% bupivacaine with S-(+)-ketamine. Value p<0.05 has been taken as a limit of statistical significance.

CONCLUSIONS

Low dose of S-(+)-ketamine administered epidurally had no sympathomimetic effects; it did not change blood pressure, pulse, serum hormones or pulse transit time. Low dose of S-(+)-ketamine administered epidurally did not deepen sympathetic block. Adding 25mg of S-(+)-ketamine to 0.5% bupivacaine does not deprive sympathetic tonus below the level of epidural block at the moment of most expressed sympathetic block and has no effect on sympathetic tonus above the block level.

背景与目的

S-(+)-氯胺酮是一种静脉麻醉药和拟交感神经药，具有局部麻醉特性。硬膜外给药时具有镇痛和局部麻醉作用，但尚无关于低剂量S-(+)-氯胺酮是否具有拟交感神经作用的数据。本研究的目的是确定硬膜外联合局部麻醉给予低剂量S-(+)-氯胺酮是否对全身及麻醉阻滞平面以下的交感神经系统有任何影响。

方法

对两组接受硬膜外麻醉的患者进行研究。一组（对照组）给予局部麻醉（0.5%布比卡因），另一组给予局部麻醉和S-(+)-氯胺酮。测量年龄、身高、体重、收缩压、舒张压和平均动脉压。采用非竞争性酶免疫化学方法（Cat Combi ELISA）测定儿茶酚胺（肾上腺素和去甲肾上腺素）浓度。使用名为Vitros Eci的机器上的发光底物免疫酶法测定皮质醇浓度。使用光电容积描记法测量脉搏传输时间。采用Mann-Whitney U检验、Wilcoxon检验和Friedman方差分析进行统计学检验。测量血压、脉搏、肾上腺素、去甲肾上腺素和皮质醇浓度以评估全身交感神经效应。

结果

对照组40例患者给予0.5%布比卡因，试验组40例患者给予0.5%布比卡因加S-(+)-氯胺酮。以p<0.05作为统计学显著性界限。

结论

硬膜外给予低剂量S-(+)-氯胺酮无拟交感神经作用；未改变血压、脉搏、血清激素或脉搏传输时间。硬膜外给予低剂量S-(+)-氯胺酮未加深交感神经阻滞。在0.5%布比卡因中加入25mg S-(+)-氯胺酮，在交感神经阻滞最明显时，不会剥夺硬膜外阻滞平面以下的交感神经张力，且对阻滞平面以上的交感神经张力无影响。