安氟醚硝酸甘油控制性降压肾素-血管紧张素系统皮质醇变化的观察  

Changes of Renin-Angiotensin System and Corticoids inControlled Hypotension induced by Enflurane and Nitroglycerate in Man

作　　者：张淑珍[1] 王恩真[1] 李忠[1] 

机构地区：[1]北京天坛医院麻醉科

出　　处：《临床麻醉学杂志》1995年第1期10-12,共3页Journal of Clinical Anesthesiology

摘　　要：２８例脑外科手术病人常规诱导，在全麻期间分别用３．５～４．０％安氟醚吸入、０．０２％硝酸甘油静脉点滴控制降压，并于诱导前、降压前、降压中、降压后分别取动脉血行放免法测定血浆肾素活性、血管紧张素、皮质醇的变化。结果：安氟醚组血浆肾素活性（ＰＲＡ）即ＡＩ值降压后高于降压前（Ｐ＜０．０１），血管紧张素（ＡⅡ）降压中明显增高（Ｐ＜０．０５）；硝酸甘油组ＡⅠ值降压中明显增高（Ｐ＜０．０１）而ＡⅡ值在各时期均无明显变化。皮质醇在两组中麻醉前均较高，麻醉后均明显下降，而降压中无明显变化。结果表明降压过程中血流动力学的改变可以激活ＲＡＳ，安氟醚麻醉下心排血量减少，外周阻力下降，血压下降使ＲＡＳ活性增强，其程度较硝酸甘油显著，而硝酸甘油降压中ＡⅡ值无明显变化可能是由于硝酸甘油降低了血管紧张素转换酶的活性所致。Hypotention was induced either by inhalation of 3.5～4.0%enflurane or intravenous drip of 0.02% nitroglyc. erate in 28 cases of intracranial operations. Arterial blood samples were taken for radioimmunological deternunationbefore anesthesia,before, during and after hypotension to observe the changes of serum renin angiotensin and cor-ticoids activity.The results:(1)in enflurane group serum renin and angiontensin I(AI)activity after hypotension was higherthan that before hypotension(P<0.01)and angiontensin(AⅡ ) increased significantly during hypotension(P<0.05).(2)in nitroglycerate group A Ⅰ increased distinctly during hypotension (P<0.01),while A Ⅱ showed no ob-vious change at all the times.(3)Corticoids showed higher levels before anesthesia ’which decreased significantly af-ter anaesthesia,but no obvious change during hypotension in both group. The results suggest that hemodynamic changes due to hypotension might activate renin-angiotensin system(RAS) in deep anesthesia with enflurane,cardiac output,peripheral resistance and blood pressure decreased conse-quently,hence raised the activity of RAS.which was more distinct than that happened in hypOtension induced by ni-trogltyerate. The fact that no changes of AⅡ during hypotension indnced by nitroglycerate may be due to the de-pression of angiotensin transformerase by nitroglycerate.

关 键 词：降压 控制性降压 安氟醚 硝酸甘油 全身麻醉 

分 类 号：R971.2[医药卫生—药品] R614.2[医药卫生—药学]