Krug G, Meltonjan G, Rathsack R, Schöntube E, Schädlich M
Klinik für Anästhesiologie und Intensivtherapie, Bereich Medizin (Charité) der Humboldt-Universität zu Berlin.
Anaesthesiol Reanim. 1990;15(3):131-6.
In 66 patients who had to undergo radical abdominal hysterectomy because of cancer of the cervix uteri, the plasma concentrations of beta-endorphin were observed intra- and postoperatively. Two anaesthetic techniques were used: neuroleptanalgesia and thoracolumbar epidural analgesia with sedation and controlled inhalation of a mixture of oxygen and nitrous oxide. While the higher dosage of analgesics administered intraoperatively resulted in markedly lower plasma concentrations of beta-endorphin, there was no such effect in the postoperative phase. Patients with epidural analgesia who were absolutely painless postoperatively had, during that stage, higher concentrations of beta-endorphin in the plasma than those patients who had been given neuroleptanalgesia. They had received no analgetic treatment during the postoperative observation period. These differences are attributed to an increased adaptability of patients subsequent to neuroleptanalgesia. The neuronal block can result in a decrease in functional activity of the suprarenal medulla and impair adaptability. The stress-induced opioid analgesia can be suppressed by circulating enkephalin from the suprarenal medulla.
在66例因子宫颈癌而必须接受根治性腹式子宫切除术的患者中，观察了其术中和术后血浆β-内啡肽的浓度。采用了两种麻醉技术：神经安定镇痛术和胸腰段硬膜外镇痛加镇静及控制性吸入氧气和一氧化二氮的混合气体。虽然术中给予较高剂量的镇痛药导致血浆β-内啡肽浓度明显降低，但术后阶段没有这种效果。术后完全无痛的硬膜外镇痛患者在此阶段血浆中的β-内啡肽浓度高于接受神经安定镇痛的患者。在术后观察期内，他们未接受镇痛治疗。这些差异归因于神经安定镇痛后患者适应性的增强。神经阻滞可导致肾上腺髓质功能活动降低并损害适应性。应激诱导的阿片类镇痛可被来自肾上腺髓质的循环脑啡肽抑制。
