纳洛酮用于全麻催醒时血浆AⅡ、E、NE、ET和ANP浓度的变化  

Effects of naioxone for analepsia of general anesthesia on plasma concentrations of A Ⅱ , E, NE, ET and ANP

作　　者：张玉平[1] 崔健君[2] 于有亮[1] 董寅元 王泓波[1] 师颖[1] 肖伟[1] 

机构地区：[1]辽宁省肿瘤医院麻醉科,沈阳市110042 [2]中国医科大学第二医院

出　　处：《中华麻醉学杂志》1998年第11期665-667,共3页Chinese Journal of Anesthesiology

摘　　要：目的:通过对血管紧张素Ⅱ(AⅡ)、肾上腺素(E)、去甲肾上腺素(NE)、内皮素(ET)及心钠素(ANP)浓度的动态观察,探讨纳洛酮(Nal)用于全麻催醒时产生并发症的原因。方法:选择择期腹部肿瘤切除手术患者36例,随机均分为Ⅰ组(Nal 0.004mg·kg^(-1))、Ⅱ组(Nal 0.002mg·kg^(-1))和Ⅲ组(生理盐水),分别于术终时静注。分别于麻醉前5分钟(T_1)、注药前5分钟(T_2)和注药后5分钟(T_3)采取静脉血标本。用高效液相色谱法测E和NE浓度,用放免法检测AⅡ、ET和ANP浓度。观察并发症发生情况。结果:在T_1和T_2时,各组内及组间各项检测指标均无明显差异。而T_3时,Ⅰ组和Ⅱ组血浆AⅡ、E及NE浓度均比T_1、T2时显著升高(P<0.01),而且也比Ⅲ组T_3时明显升高(P<0.01)。用药后,Ⅰ、Ⅱ组患者切口疼痛、高血压及躁动等并发症发生率明显高于Ⅲ组(P<0.05)。结论:纳洛酮用于全麻催醒可使血浆AⅡ、E和NE浓度明显升高。上述物质及其协同作用,可能就是纳洛酮催醒全麻后引发的一系列并发症的主要原因。Objective: To investigate the cause of complications after naloxone (Nal) for administration analepsia of general anesthesia. Method: Thirty-six cases were randomly divided into group Ⅰ (n=12, Nal 0.004mg·kg^(-1)), group Ⅱ (n=12,Na1 0.002mg·kg^(-1)) and group Ⅲ (n=12,NS). The dosage was administrated intravenously in a bolus at the end of operation. The venous blood samples were taken respectively before anesthesia (T_1),Smin before and after the administration (T_1 ,T_3) to measure the plasma concentration of E and NE with high performance liquid chromatography,and those of A Ⅱ, ET and ANP with radioimmunoassay. The complications after the administration were observed. Result: Compared with T_1 and T_2, the plasma concentrations of A Ⅱ, E and NE obviously increased at T_3 in group Ⅰ and group Ⅱ (P<0.01), which were also higher than those at T_3 in group Ⅲ (P<0.01). The plasm concentrations of ET and ANP were no significantly different among all groups. The analeptic time was markedly shorter in group Ⅰ and group Ⅱ (P<0.01), but the incidences of incision pain, hypertension and dysphoria were obviously higher in group Ⅰ and group Ⅱ than these in group Ⅱ (P<0.05). Conclusion: The complications during analepsia may result from the increase of plasma concentrations of E,NE and A Ⅱ induced with naloxone.

关 键 词：纳洛酮 兴奋药 全身麻醉 并发症 

分 类 号：R614.2[医药卫生—麻醉学] R971.93[医药卫生—外科学]