Kayhan Z, Aldemir D, Mutlu H, Oğüş E
Baskent University, Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey.
Eur J Anaesthesiol. 2005 Oct;22(10):780-5. doi: 10.1017/s0265021505001298.
We have investigated the concentrations of epinephrine, norepinephrine, vasopressin and angiotensin converting enzyme activity to explore the role of these mediators in the neuroendocrine response to laryngoscopy and tracheal intubation.
One hundred (50 male, 50 female) ASA I patients aged 20-50 yr (mean+/-SEM; 35.59+/-0.99) were included in the study. They were undergoing elective surgery under standard anaesthesia induction and maintenance using tracheal intubation. Plasma concentrations of epinephrine, norepinephrine and vasopressin as well as plasma angiotensin converting enzyme activity were determined at four time points, before (T1) and after (T2) induction, and 2 (T3) and 5 min (T4) after intubation. Blood pressure and heart rate were recorded at corresponding times to reveal if any correlation existed between haemodynamic parameters and neuroendocrine response.
Heart rate increased after induction and intubation (P<0.05) and decreased significantly at T4 (P<0.05). Systolic blood pressure decreased significantly (P<0.05) after induction and increased slightly after intubation decreasing to below baseline value (P<0.05) at T4. Diastolic blood pressure increased slightly after intubation and decreased significantly (P<0.05) at T4. Plasma epinephrine and norepinephrine concentrations decreased after induction and increased at T3 and T4 without reaching significance. Vasopressin concentrations increased slightly at T2 and T3 and decreased significantly at T4 (P<0.05). Angiotensin converting enzyme activity was unaffected when compared with baseline values.
Blood pressure, heart rate, plasma epinephrine, norepinephrine and vasopressin concentrations increased slightly in response to laryngoscopy and intubation, all returning to or below baseline 5 min later with no change in angiotensin converting enzyme activity in normotensive patients.
我们研究了肾上腺素、去甲肾上腺素、血管加压素的浓度以及血管紧张素转换酶活性，以探讨这些介质在喉镜检查和气管插管的神经内分泌反应中的作用。
本研究纳入了100例（50例男性，50例女性）年龄在20 - 50岁（平均±标准误；35.59±0.99）的ASA I级患者。他们在标准麻醉诱导和气管插管维持下接受择期手术。在四个时间点测定血浆肾上腺素、去甲肾上腺素和血管加压素的浓度以及血浆血管紧张素转换酶活性，分别为诱导前（T1）、诱导后（T2）、插管后2分钟（T3）和5分钟（T4）。在相应时间记录血压和心率，以揭示血流动力学参数与神经内分泌反应之间是否存在任何相关性。
诱导和插管后心率增加（P<0.05），在T4时显著下降（P<0.05）。诱导后收缩压显著下降（P<0.05），插管后略有升高，在T4时降至基线值以下（P<0.05）。插管后舒张压略有升高，在T4时显著下降（P<0.05）。诱导后血浆肾上腺素和去甲肾上腺素浓度下降，在T3和T4时升高但未达到显著水平。血管加压素浓度在T2和T3时略有升高，在T4时显著下降（P<0.05）。与基线值相比，血管紧张素转换酶活性未受影响。
在血压正常的患者中，喉镜检查和插管后血压、心率、血浆肾上腺素、去甲肾上腺素和血管加压素浓度略有升高，5分钟后均恢复至或低于基线水平，血管紧张素转换酶活性无变化。
