硬膜外麻醉下血浆内源性阿片肽水平与胆心反射  

Plasma Endogenous Opioid Peptides Levels and Cholecysto cardiac Reflex under Epidural Anesthesia

作　　者：柴小青[1] 陈昆洲[1] 阎淑珍[1] 戴玲[1] 

机构地区：[1]安徽省立医院麻醉科

出　　处：《临床麻醉学杂志》1997年第4期215-217,共3页Journal of Clinical Anesthesiology

摘　　要：采用放射免疫分析法（ＲＩＡ）测定３０例硬膜外麻醉胆囊切除术中血浆内源性阿片肽（ＥＯＰ）水平变化，并观察其与ＭＡＰ、ＨＲ变化间的相互关系，探讨ＥＯＰ在胆心反射中的作用。结果表明，硬膜外麻醉本身对ＥＯＰ释放无明显影响。进腹探查激活ＥＯＰ系统，血浆强啡肽（ＤｙｎＡ１—１３）水平呈上升趋势，β－内啡肽（β－ＥＰ）水平显著升高（Ｐ＜０．０５）。牵拉／分离胆囊时胆心反射组血浆ＤｙｎＡ１—１３水平急剧增高（Ｐ＜０．０１），与ＭＡＰ、ＨＲ呈显著负相关（ｒ＝－０．８５１３，－０．９３７６，Ｐ＜０．０１），对照组ＤｙｎＡ１—１３升高不明显（Ｐ＞０．０５），两组比较差异非常显著（Ｐ＜０．０１）。提示β－ＥＰ与ＤｙｎＡ１—１３在抑制交感／兴奋迷走方面可能存在叠加作用，ＤｙｎＡ１—１３水平急剧增高参与牵拉／分离胆囊时胆心反射的发生发展。Plasma endogenous opioid peptides(EOP)were detected using radioimmunossay in 30 cholecystectomy patients under epidural anesthesia. The relationship between the EOP levels and MAP/HR was evaluated. The results:(1)Epidural anesthesia alone had no effect on the release of EOP.(2)During surgical manipulation of the gallbladder, EOP system was activated, and plasma DynA 1-13 tended to rise and β EP increased significantly (P<0 05).(3)Stretching/denuding of the gallbladder induced cholecysto cardiac reflex and plasma DynA 1—13 level rose sharply (P<0 01),which was negatively correlated with MAP/HR. The conclusions:(1)β EP and DynA 1—13 take part in inhibiting sympathetic and exciting vagi.(2)The sharp increase of DynA 1—13 is invulved in occurrence and development of the cholecysto cardiac reflex.

关 键 词：强啡肽 β-内啡肽 胆心反射 硬膜外腔 阻滞麻醉 

分 类 号：R614.42[医药卫生—麻醉学]