Duda D, Lorenz W, Celik I
Klinik für Anästhesie, Katholisches Klinikum Mainz-St. Hildegardis, Akademisches Lehrkrankenhaus, Johannes Gutenberg-Universität Mainz.
Anaesthesiol Reanim. 2003;28(4):97-103.
Mesenteric traction syndrome occurs during abdominal surgery and is described as sudden tachycardia, hypotension and flush. Among other etiological factors, eventeration or mesenteric traction of the small intestine may cause histamine release from mesenteric mast cells. Therefore, our hypothesis was that mesenteric traction syndrome could be positively influenced by prophylactic administration of H1- and and H2-antihistamines. Seventeen male patients (ASA groups III-V, 48-78 years old) were investigated in a randomised double blind study during elective abdominal aortic aneurysm (AAA) repair; which, in our opinion, is one of the most standardised surgical procedures. Eight patients had pre-anaesthetic prophylaxis with 0.1 mg/kg BW dimetindene (H1-receptor antagonist) plus 5 mg/kg BW cimetidine (H2-receptor antagonist) diluted with 100 ml 0.9% NaCl, while 9 patients received a placebo (100 ml 0.9% NaCl). Anaesthesia and invasive haemodynamic monitoring were standardised in all patients. Haemodynamic parameters, plasma histamine concentrations and clinical symptoms were determined one min after skin incision (HS), and 5 and 20 min after mesenteric traction (5' EV and 20' EV). Statistical analyses were performed using the Student's t-test, the Mann-Whitney-U-test for continuous data and Chi2-test for incidences. The incidence of histamine release was 55.5% (5/9) in the placebo group vs. 37.5% (3/8) in the antihistamine group (p > 0.05, Chi2-test). Plasma histamine levels (mean +/- SD) were higher in the placebo group than in the antihistamine group at 5 and 20 min after mesenteric traction, but there was no statistical significance. Arrhythmias were significantly more frequent in the placebo group (6 times) than in the antihistamine group (none) (p = 0.005 Chi2-test). Systolic blood pressure was not statistically different between the groups (e.g. 5 min after mesenteric traction, mean +/- SD; placebo 111 +/- 20 mm Hg vs. antihistamines 119 +/- 35 mm Hg). In the placebo group, however, the haemodynamics only stabilised 5 min after mesenteric traction when anaesthetic gas concentration was repeatedly reduced and vasopressor/volume administration was increased (placebo group = 20 times vs. antihistamine group = 8 times (p = 0.001, Chi2-test). From these results we conclude that prophylactic administration of antihistamines reduces in particular the incidence of arrhythmias and the number of stabilising measures during mesenteric traction. Prophylaxis with H1- and H2-antihistamines may therefore be of perioperative benefit and should be considered in AAA surgery.
肠系膜牵引综合征发生于腹部手术期间，表现为突发心动过速、低血压和脸红。在其他病因中，小肠膨出或肠系膜牵引可能导致肠系膜肥大细胞释放组胺。因此，我们的假设是预防性给予H1和H2抗组胺药可能对肠系膜牵引综合征产生积极影响。在择期腹主动脉瘤（AAA）修复手术期间，对17例男性患者（ASA分级III - V级，48 - 78岁）进行了一项随机双盲研究；在我们看来，这是最标准化的外科手术之一。8例患者在麻醉前用0.1mg/kg体重的二甲茚定（H1受体拮抗剂）加5mg/kg体重的西咪替丁（H2受体拮抗剂）以100ml 0.9%氯化钠稀释进行预防，而9例患者接受安慰剂（100ml 0.9%氯化钠）。所有患者的麻醉和有创血流动力学监测均标准化。在皮肤切开后1分钟（HS）、肠系膜牵引后5分钟和20分钟（5'EV和20'EV）测定血流动力学参数、血浆组胺浓度和临床症状。使用Student's t检验、连续数据的Mann - Whitney - U检验和发病率的Chi2检验进行统计分析。安慰剂组组胺释放的发生率为55.5%（5/9），抗组胺药组为37.5%（3/8）（p>0.05，Chi2检验）。肠系膜牵引后5分钟和20分钟时，安慰剂组的血浆组胺水平（均值±标准差）高于抗组胺药组，但无统计学意义。安慰剂组心律失常的发生率（6次）显著高于抗组胺药组（无）（p = 0.005，Chi2检验）。两组间收缩压无统计学差异（例如，肠系膜牵引后5分钟，均值±标准差；安慰剂组111±20mmHg，抗组胺药组119±35mmHg）。然而，在安慰剂组中，只有在反复降低麻醉气体浓度并增加血管升压药/液体输注量后，肠系膜牵引5分钟后血流动力学才稳定（安慰剂组 = 20次，抗组胺药组 = 8次（p = 0.001，Chi2检验）。从这些结果我们得出结论，预防性给予抗组胺药尤其可降低肠系膜牵引期间心律失常的发生率和稳定措施的次数。因此，H1和H2抗组胺药预防可能具有围手术期益处，在AAA手术中应予以考虑。
