Oehmke M J, Podranski T, Mann M, Frickey N, Kuhn D F M, Hempelmann G
Department of Special Anaesthesia and Pain Control, Medical University of Vienna, Vienna, Austria.
Acta Anaesthesiol Scand. 2008 Apr;52(4):487-92. doi: 10.1111/j.1399-6576.2007.01551.x.
Catecholamine release is a physiological response to stress. The extent to which perioperative stress provokes the central release of catecholamines, which modulate pain perception in the spinal cord, still remains unknown. The perioperative course of catecholamine concentrations in the cerebrospinal fluid (CSF) and plasma was examined.
A prospective study was performed in 25 patients (ASA III, 60-84 years) undergoing elective hip joint replacement in spinal catheter anesthesia. The concentrations of dopamine, epinephrine and norepinephrine in the CSF and plasma were measured before anesthesia, immediately after surgery, and 6 and 24 h post-operatively.
In most patients, dopamine and epinephrine were not detectable in CSF. CSF-norepinephrine concentrations decreased from median [interquartile-range] 159 [124;216] pre-anesthesia to 116 [79;152] pmol/l immediately post-operatively and were slightly elevated 24 h post-operatively (180 [134;302] pmol/l) (P=0.05). Dopamine plasma concentrations were not detectable or were barely above the detection threshold. Plasma epinephrine increased from 61 [28;77] pmol/l pre-anesthesia to 112 [69;138] pmol/l 6 h post-operatively and returned to baseline 24 h post-operatively (P=0.001). Plasma norepinephrine concentrations increased intra-operatively from 298 [249;422] to 556 [423;649] pmol/l and remained elevated 24 h after surgery (P=0.009). There was no association between changes in CSF or plasma norepinephrine or epinephrine concentrations and changes in heart rate (HR) or mean arterial pressure (MAP).
During spinal anesthesia for elective hip joint replacement, norepinephrine concentrations were greater in plasma than in CSF. CSF dopamine and epinephrine concentrations were essentially undetectable. The changes in CSF-norepinephrine concentrations and the changes of plasma norepinephrine concentrations showed no association with each other; nor were there correlations between clinical stress parameters (HR, MAP) or visual analog scale pain, and the changes in CSF norepinephrine concentrations.
儿茶酚胺释放是对压力的一种生理反应。围手术期应激在多大程度上引发调节脊髓疼痛感知的儿茶酚胺的中枢释放仍不清楚。本研究检测了脑脊液（CSF）和血浆中儿茶酚胺浓度的围手术期变化过程。
对25例（ASA III级，60 - 84岁）接受脊髓导管麻醉下择期髋关节置换术的患者进行前瞻性研究。在麻醉前、手术后即刻以及术后6小时和24小时测量CSF和血浆中多巴胺、肾上腺素和去甲肾上腺素的浓度。
在大多数患者中，CSF中未检测到多巴胺和肾上腺素。CSF去甲肾上腺素浓度从麻醉前的中位数[四分位数间距]159[124；216]pmol/l降至术后即刻的116[79；152]pmol/l，并在术后24小时略有升高（180[134；302]pmol/l）（P = 0.05）。多巴胺血浆浓度未检测到或仅略高于检测阈值。血浆肾上腺素从麻醉前的61[28；77]pmol/l升至术后6小时的112[69；138]pmol/l，并在术后24小时恢复至基线水平（P = 0.001）。血浆去甲肾上腺素浓度在术中从298[249；422]升至556[423；649]pmol/l，并在术后24小时仍保持升高（P = 0.009）。CSF或血浆中去甲肾上腺素或肾上腺素浓度的变化与心率（HR）或平均动脉压（MAP）的变化之间无关联。
在择期髋关节置换术的脊髓麻醉期间，血浆中的去甲肾上腺素浓度高于CSF。CSF中的多巴胺和肾上腺素浓度基本无法检测到。CSF去甲肾上腺素浓度的变化与血浆去甲肾上腺素浓度的变化之间无关联；临床应激参数（HR、MAP）或视觉模拟评分疼痛与CSF去甲肾上腺素浓度的变化之间也无相关性。
