可乐定在腹腔镜胆囊切除术中具有节省阿片类药物的作用、稳定的血流动力学及肾脏完整性。
Clonidine provides opioid-sparing effect, stable hemodynamics, and renal integrity during laparoscopic cholecystectomy.
作者信息
Laisalmi M, Koivusalo A M, Valta P, Tikkanen I, Lindgren L
机构信息
Department of Anaesthesia and Intensive Care Medicine, Surgical Hospital, Helsinki University Central Hospital, 00029 HUS Helsinki, Finland.
出版信息
Surg Endosc. 2001 Nov;15(11):1331-5. doi: 10.1007/s004640090126. Epub 2001 Aug 16.
BACKGROUND
Carbon dioxide pneumoperitoneum causes a hemodynamic stress response and decreases urine output because of an activated renin-angiotensin-aldosterone system (RAAS). Clonidine is a potent antihypertensive drug that suppresses RAAS.
METHODS
The effects of clonidine 4.5 mg/kg or saline on hemodynamics, neuroendocrine response, and renal parameters were compared in 30 healthy patients undergoing laparoscopic cholecystectomy.
RESULTS
Heart rate, arterial blood pressures, and plasma renin activity were lower during and after pneumoperitoneum in patients with clonidine. There were no differences in urine output, urine oxygen tension (reflecting medullary perfusion), or antidiuretic hormone between the groups. N-acetyl-b-D-glucosaminidase, a marker of proximal tubular damage, was minimally elevated after clonidine.
CONCLUSIONS
Clonidine enabled stable hemodynamics and prevented activation of RAAS seen as unchanged plasma renin activity. Clonidine may be beneficial during laparoscopy in patients with hypertension, cardiovascular, and/or renal diseases.
背景
二氧化碳气腹由于激活肾素-血管紧张素-醛固酮系统（RAAS）而引起血流动力学应激反应并减少尿量。可乐定是一种强效抗高血压药物，可抑制RAAS。
方法
在30例接受腹腔镜胆囊切除术的健康患者中，比较了4.5mg/kg可乐定或生理盐水对血流动力学、神经内分泌反应和肾脏参数的影响。
结果
可乐定治疗患者在气腹期间及气腹后心率、动脉血压和血浆肾素活性较低。两组间尿量、尿氧张力（反映髓质灌注）或抗利尿激素无差异。可乐定治疗后，近端肾小管损伤标志物N-乙酰-β-D-氨基葡萄糖苷酶轻度升高。
结论
可乐定可使血流动力学稳定，并防止因血浆肾素活性未改变而出现的RAAS激活。可乐定可能对高血压、心血管和/或肾脏疾病患者的腹腔镜手术有益。
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