Greif R, Laciny S, Rajek A M, Larson M D, Bjorksten A R, Doufas A G, Bakhshandeh M, Mokhtarani M, Sessler D I
Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, California, USA.
Anesth Analg. 2001 Sep;93(3):620-7. doi: 10.1097/00000539-200109000-00018.
The special antishivering action of meperidine may be mediated by its kappa or anticholinergic actions. We therefore tested the hypotheses that nalbuphine or atropine decreases the shivering threshold more than the vasoconstriction threshold. Eight volunteers were each evaluated on four separate study days: 1) control (no drug), 2) small-dose nalbuphine (0.2 microg/mL), 3) large-dose nalbuphine (0.4 microg/mL), and 4) atropine (1-mg bolus and 0.5 mg/h). Body temperature was increased until the patient sweated and then decreased until the patient shivered. Nalbuphine produced concentration-dependent decreases (mean +/- SD) in the sweating (-2.5 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.75 +/- 0.25), vasoconstriction (-2.6 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.75 +/- 0.25), and shivering (-2.8 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.79 +/- 0.23) thresholds. Atropine significantly increased the thresholds for sweating (1.0 degrees C +/- 0.4 degrees C), vasoconstriction (0.9 degrees C +/- 0.3 degrees C), and shivering (0.7 degrees C +/- 0.3 degrees C). Nalbuphine reduced the vasoconstriction and shivering thresholds comparably. This differs markedly from meperidine, which impairs shivering twice as much as vasoconstriction. Atropine increased all thresholds and would thus be expected to facilitate shivering. Our results thus fail to support the theory that activation of kappa-opioid or central anticholinergic receptors contribute to meperidine's special antishivering action.
哌替啶的特殊抗寒战作用可能由其κ受体或抗胆碱能作用介导。因此，我们检验了以下假设：纳布啡或阿托品降低寒战阈值的程度大于血管收缩阈值。8名志愿者在4个不同的研究日接受评估：1）对照（无药物），2）小剂量纳布啡（0.2μg/mL），3）大剂量纳布啡（0.4μg/mL），4）阿托品（1mg推注和0.5mg/h）。体温升高直至患者出汗，然后降低直至患者寒战。纳布啡使出汗（-2.5±1.7℃·μg⁻¹·mL；r² = 0.75±0.25）、血管收缩（-2.6±1.7℃·μg⁻¹·mL；r² = 0.75±0.25）和寒战（-2.8±1.7℃·μg⁻¹·mL；r² = 0.79±0.23）阈值呈浓度依赖性降低。阿托品显著提高了出汗（1.0℃±0.4℃）、血管收缩（0.9℃±0.3℃）和寒战（0.7℃±0.3℃）阈值。纳布啡同等程度地降低了血管收缩和寒战阈值。这与哌替啶明显不同，哌替啶损害寒战的程度是血管收缩的两倍。阿托品提高了所有阈值，因此预计会促进寒战。因此，我们的结果未能支持κ阿片受体或中枢抗胆碱能受体激活有助于哌替啶特殊抗寒战作用的理论。
