Valladares Mendías J C, Alaminos Mingorance M, Castejón Casado J, Moreno Prieto M, Ramírez Navarro A
Servicio de Cirugía Pediátrica, Hospital Universitario Virgen de las Nieves, Granada.
Cir Pediatr. 2000 Oct;13(4):145-9.
The study on the physiological alterations due to surgical aggression (surgical stress), widely investigated in adults, is less known in paediatric age.
Of this work is to quantify surgical stress (evaluated by means of Oxford Scale as high or low depending on its value bigger or lower than 6), after determining changes of plasmatic concentrations of ACTH, beta-endorphin and cortisol in operated children.
Observational analytic design of a prospective cohort with internal comparison of the groups.
33 (age 10 +/- 2.6 years; range 5 to 14 years).
plasmatic concentrations of ACTH, beta-endorphin and cortisol determined before and after the intervention (1 and 24 hours after surgery), by radio-immune-analysis.
Significative increase of the three considered hormones one hour after surgery, with decrease of them until preoperative levels 24 hours later. Significative correlation between beta-endorphin (24 hours after surgery), cortisol (1 hour after surgery) and surgical stress levels.
Surgery in children provokes the activation of hipophysal-suprarrenal system. These levels early came back to normal ones, 24 hours after surgery. There is a specific change in beta-endorphin, that is why it is possible to assure that beta-endorphin is a "stress-hormone", since it is affected by surgical aggression. Cortisol seems to be a good index of level of surgical stress.
关于手术侵袭（手术应激）所导致的生理改变的研究，在成年人中已得到广泛调查，但在儿童时期却鲜为人知。
在于通过测定手术患儿血浆中促肾上腺皮质激素（ACTH）、β-内啡肽和皮质醇浓度的变化，来量化手术应激（根据牛津量表，依据其值大于或小于6来评估为高或低）。
采用前瞻性队列的观察性分析设计，并进行组内比较。
33例（年龄10±2.6岁；范围5至14岁）。
通过放射免疫分析法在干预前以及干预后（手术后1小时和24小时）测定血浆中ACTH、β-内啡肽和皮质醇的浓度。
术后1小时，所考虑的三种激素均显著增加，而在24小时后降至术前水平。术后24小时的β-内啡肽、术后1小时的皮质醇与手术应激水平之间存在显著相关性。
儿童手术会引发垂体-肾上腺系统的激活。这些水平在术后24小时早期恢复正常。β-内啡肽存在特定变化，这就是为何可以确定β-内啡肽是一种“应激激素”，因为它受手术侵袭影响。皮质醇似乎是手术应激水平的良好指标。
