地氟醚预处理存在一个阈浓度，可被重复应用所降低，该效应由β2-肾上腺素能受体介导。

Desflurane-induced preconditioning has a threshold that is lowered by repetitive application and is mediated by beta 2-adrenergic receptors.

机构信息

Department of Anesthesiology and Critical Care, University of Würzburg, Würzburg, Germany.

出版信息

J Cardiothorac Vasc Anesth. 2009 Oct;23(5):607-13. doi: 10.1053/j.jvca.2009.01.016. Epub 2009 Mar 19.

DOI:10.1053/j.jvca.2009.01.016

PMID:19303329

Abstract

OBJECTIVE

An optimal administration protocol to induce a maximal effect of anesthetic preconditioning has not been evaluated to date. In this study, desflurane preconditioning was characterized with respect to its threshold, dose dependency, and continuous versus repetitive application. Furthermore, the role of beta(2)-adrenergic receptors in anesthetic preconditioning was tested.

DESIGN

A randomized controlled study.

SETTING

Laboratory study in a University hospital.

SUBJECTS

New Zealand white rabbits in vivo.

INTERVENTIONS

Systemic hemodynamics were continuously measured. Rabbits were subjected to 30 minutes of coronary artery occlusion and 3 hours of reperfusion. Animals received desflurane continuously for 30 minutes at 0.5, 1.0, or 1.5; desflurane for 90 minutes at 0.5 or 1.5 MAC; or repetitively for three 10-minute periods at 0.5, 1.0, or 1.5 MAC before coronary occlusion. The beta(2)-adrenergic receptor blocker ICI 118,551 (0.2 mg/kg) or saline placebo was given in the absence or presence of 1.0 MAC desflurane. Myocardial infarct size was measured with triphenyltetrazolium staining.

MEASUREMENTS AND MAIN RESULTS

Myocardial infarct size was 61% +/- 5% in control experiments. Desflurane, administered continuously at 0.5 MAC for 30 minutes (52% +/- 4%) or 90 minutes (56% +/- 8%) had no effect, whereas 0.5 MAC of desflurane given repetitively reduced infarct size to 36% +/- 7%. Desflurane administered continuously for 30 minutes at 1.0 or 1.5 MAC reduced infarct size to 35% +/- 5% and 39% +/- 4%, respectively. Repetitive application at 1.0 MAC (37% +/- 6%) or 1.5 MAC (29% +/- 4%) and continuous administration of 1.5 MAC for 90 minutes (32% +/- 6%) did not result in further infarct size reduction. ICI 118,551 did not affect infarct size (53% +/- 2%) but abolished desflurane preconditioning (51% +/- 5%).

CONCLUSION

beta(2)-Adrenergic receptors mediate desflurane-induced preconditioning. Desflurane-induced preconditioning has a threshold that can be lowered by repetitive administration.

摘要

目的

目前尚未对能产生最大麻醉预处理效果的最佳给药方案进行评估。本研究旨在对七氟醚预处理的阈浓度、剂量依赖性以及连续与重复应用进行特征描述，并检验β2-肾上腺素能受体在麻醉预处理中的作用。

设计

随机对照研究。

地点

大学医院实验室。

对象

新西兰白兔体内。

干预措施

持续测量全身血流动力学。兔子接受 30 分钟冠状动脉闭塞和 3 小时再灌注。动物接受 30 分钟浓度为 0.5、1.0 或 1.5 的七氟醚连续输注，或 90 分钟 0.5 或 1.5 MAC 的七氟醚输注，或在冠状动脉闭塞前重复给予 3 个 10 分钟时程、浓度为 0.5、1.0 或 1.5 MAC 的七氟醚输注。β2-肾上腺素能受体阻滞剂 ICI 118,551（0.2mg/kg）或生理盐水安慰剂在不存在或存在 1.0 MAC 七氟醚的情况下给予。用三苯基四唑染色法测量心肌梗死面积。

测量和主要结果

在对照实验中，心肌梗死面积为 61%±5%。0.5 MAC 七氟醚连续输注 30 分钟（52%±4%）或 90 分钟（56%±8%）均无效果，而 0.5 MAC 七氟醚重复应用可使梗死面积减少至 36%±7%。0.5 MAC 七氟醚连续输注 30 分钟或 1.0 或 1.5 MAC 输注 90 分钟，分别使梗死面积减少至 35%±5%和 39%±4%。1.0 MAC 重复应用（37%±6%）或 1.5 MAC 重复应用（29%±4%）以及 1.5 MAC 连续输注 90 分钟（32%±6%）均未使梗死面积进一步减小。ICI 118,551 不影响梗死面积（53%±2%），但可消除七氟醚预处理作用（51%±5%）。