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目的探讨氯胺酮静脉用药对机体部分凝血机制的的影响及其对心血管系统负性肌力效应之间的关系。方法选择连续硬膜外利多卡因阻滞麻醉下腹部手术36例,其中20例于麻醉中静脉辅助应用氯胺酮(2rag/kg).全部病例于入院后、手术开始前、手术l 5min、2h时采静脉血测定血小板计数(PC)、血小板粘附(PAd)、聚集(PAg)功能;部分凝血活酶时同(KPTT)、凝血酶原时间(PT)和凝血酶时间(TT)。结果术中氯胺酮组PC比对照组低(P<0.05)且低于术前(P<0.05);PAd、PAg明显高于对照组(P<0.01);PT和KPTT呈缩短趋势,但无统计学差异。结论氯胺酮有激话血小板,增加血小板粘附、聚集和释放作用.增强术中内、外凝性凝血系统因子的促凝活性,这是其引起并加重心肌循环障碍产生负性肌力效应的主要原因,故不利于休克和心肌缺血性病人的麻醉。
Objective To investigate the effect of ketamine intravenous drug on the partial coagulation mechanism of the body and its relationship with the negative inotropic effect of cardiovascular system. Methods Thirty-six cases underwent continuous epidural lidocaine anesthesia under abdominal anesthesia, of which 20 cases received intravenous ketamine (2rag / kg) during anesthesia. All patients were admitted to hospital before surgery, l5min and 2h Venous blood was collected for determination of platelet count (PC), platelet adhesion (PAd), aggregation (PAg) function; partial thromboplastin time (PTT) and thrombin time (TT). Results Intraoperative ketamine group PC was lower than the control group (P <0.05) and lower than preoperative (P <0.05), PAd, PAg was significantly higher than the control group (P <0.01); PT and KPTT showed a trend of shortening, but no statistics Differences Conclusions Ketamine has stimulated platelets and increases platelet adhesion, aggregation and release, and enhances procoagulant activity of intra and extra coagulative coagulation system factors, which are the main factors that cause and aggravate negative inotropic effects of myocardial circulation disorders Reason, it is not conducive to shock and myocardial ischemia in patients with anesthesia.