Thwaites B K, Nigus D B, Bouska G W, Mongan P D, Ayala E F, Merrill G A
Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6345, USA.
Anesth Analg. 1995 Jul;81(1):119-24. doi: 10.1097/00000539-199507000-00024.
Ketorolac (KT) prolongs bleeding time and inhibits platelet aggregation and platelet thromboxane production in healthy, awake volunteers. However, platelet function may be accentuated during the stress of general anesthesia (GA) and surgery. The purpose of this study was to investigate platelet function changes during a standard GA technique and surgery, as well as after a single intraoperative dose of intravenous (i.v.) KT. The study comprised 30 ASA physical status I patients undergoing GA for knee arthroscopy. Subjects were randomized to receive either KT 60 mg IV 15 min after skin incision or placebo i.v. Platelet function testing consisted of an Ivy bleeding time (BT), platelet aggregometry (PA) with adenosine diphosphate (ADP) and collagen, thromboelastography (TEG), and serum thromboxane B2 assays (TxB2). Platelet function testing was performed: 1) 15 min prior to the induction of GA, 2) 10 min after skin incision, and 3) 45 min after administration of study drug. BT decreased significantly in the placebo group from 263 +/- 133 s (mean +/- SD) preoperatively to 207 +/- 89 s postincision. BT did not change in the KT group. PA was unchanged after IV KT. TEG data was unchanged in both groups during anesthesia and surgery. TxB2 levels decreased markedly in the KT group from 106.9 +/- 96.2 ng/mL preoperatively to 0.4 +/- 1.2 ng/mL poststudy drug, P = 0.002. Platelet function appears to be accentuated during GA and surgery as evaluated by BT in the placebo group. Further, platelet function by BT, PA, and TEG was not inhibited after i.v. KT despite near complete abolition of TxB2 production.
酮咯酸（KT）可延长健康清醒志愿者的出血时间，并抑制血小板聚集和血小板血栓素生成。然而，在全身麻醉（GA）和手术应激期间，血小板功能可能会增强。本研究的目的是调查在标准GA技术和手术期间以及术中单次静脉注射（i.v.）KT后血小板功能的变化。该研究包括30例接受膝关节镜检查GA的ASA身体状况I级患者。受试者被随机分为在皮肤切口后15分钟接受静脉注射60mg KT或静脉注射安慰剂。血小板功能测试包括Ivy出血时间（BT）、用二磷酸腺苷（ADP）和胶原进行的血小板聚集测定（PA）、血栓弹力图（TEG）和血清血栓素B2测定（TxB2）。血小板功能测试在以下时间进行：1）GA诱导前15分钟；2）皮肤切口后10分钟；3）研究药物给药后45分钟。安慰剂组的BT从术前的263±133秒（平均值±标准差）显著降至切口后的207±89秒。KT组的BT没有变化。静脉注射KT后PA没有变化。在麻醉和手术期间，两组的TEG数据均未改变。KT组的TxB2水平从术前的106.9±96.2 ng/mL显著降至研究药物给药后的0.4±1.2 ng/mL，P = 0.002。如安慰剂组通过BT评估所示，在GA和手术期间血小板功能似乎增强。此外，尽管TxB2生成几乎完全被消除，但静脉注射KT后，BT、PA和TEG所评估的血小板功能并未受到抑制。
