急性失血所致的麻醉深度变异性及机制探讨

Variability of anesthetic depth resulted from acute hemorrhage and its mechanism

  • 摘要: 目的: 为探讨急性失血患者对麻醉深度耐受性的影响及与血浆β-内啡肽改变的关系,本文通过动物实验对失血状态下麻醉药最低肺泡有效浓度(MAC)和β-内啡肽浓度变化进行研究。方法: ①新西兰兔2 0只随机分成对照组和失血组。连续监测MAP、CVP、PETCO2和ECG;②测定对照组七氟醚MAC;失血组经动脉放血将MAP降至基础值的2/3,测定失血状态下七氟醚MAC;③两组动物分别于下列时间点测定血浆β-内啡肽浓度:实验前、实验准备后、实验准备后30min和6 0min或失血后5min和30min、MAC测定点(即夹尾呈阳性反应点和夹尾呈阴性反应点)。结果: ①对照组和失血组七氟醚MAC分别为(2.2± 0.2)%和(1.6± 0.1)%;②失血后β-内啡肽浓度较对照组显著升高。失血后5min和30minβ-内啡肽浓度较对照组高(50± 9)%和(58± 10)%;结论: 新西兰兔七氟醚MAC为(2.2± 0.2)%,急性失血引起体内β-内啡肽大量释放,产生镇痛作用,这也是减少对麻醉药需求的原因之一。

     

    Abstract: Objective: In order to explore the variability of anesthetic depth in hemorrhagic patients and its mechanism, the study investigated how MAC and β-endorphin changed in state of hemorrhagic hypotension. Methods: ① 20 New Zealand rabbits were randomly divided into control group and hemorrhage group. MAP、CVP、P ET CO 2 and ECG were monitored continuously. ② The MAC of sevoflurane was measured in the two groups in which MAP of hemorrhage group was dropped to two third of baseline by bloodletting. ③ Plasma β-endrophin concentration was assaied repeatedly in two groups. Results: ① MAC of sevoflurane was (2.2±0.2)% in control group and (1.6±0.1)% in hemorrhage group. ② Hemorrhage induced increase of plasma β-endorphin concentration significantly. 5 min and 30 min after bloodletting, β-endorphin concentration increased (50±9)% and (58±10)%, respectively. Conclusion: MAC of sevoflurane in rabbits is (2. 2±0.2)%. Acute hemorrhage could induce endogenous β-endorphin releasing enormously, which maybe one of the mechanisms to reduce MAC of inhalational anesthetic.

     

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