Brandt M R, Korshin J, Hansen A P, Hummer L, Madsen S N, Rygg I, Kehlet H
Acta Anaesthesiol Scand. 1978;22(4):400-12. doi: 10.1111/j.1399-6576.1978.tb01316.x.
Twelve patients scheduled for aortic valve replacement during extracorporal circulation were randomly allocated to either morphine anaesthesia or fluroxene anaesthesia. Morphine in a total dose of 4 mg/kg was administered before skin incision. At the start of extracorporal circulation all patients received 25 g glucose intravascularly. The endocrine-metabolic response to surgery, as expressed by changes in plasma ACTH, cortisol, insulin, growth hormone, cyclic adenosine-3',-5'-monophosphate (cyclic AMP), glucose, free fatty acids, blood b-hydroxybutyrate and cumulative nitrogen balance was measured before and during anaesthesia and surgery, and on the first five post-operative days. It was found that morphine anaesthesia blocked the increase in ACTH, cortisol, growth hormone, cyclic AMP, and glucose during surgery. However, after initiation of extracorporal circulation only ACTH, cortisol, and, to a lesser degree, the glucose and insulin response to glucose were lowered by morphine anaesthesia. From the first to the fifth days after operation no differences between the two groups could be demonstrated in any parameter. Cumulative nitrogen balance was similar in the two groups. It is concluded that morphine in large doses administered before skin incision inhibits the initial endocrine-metabolic response to open-heart surgery, but that the effect is short-lasting and without effect on overall postoperative protein catabolism.
12名计划在体外循环期间进行主动脉瓣置换术的患者被随机分配接受吗啡麻醉或氟烷麻醉。在皮肤切口前给予总量为4mg/kg的吗啡。在体外循环开始时，所有患者均接受25g葡萄糖静脉注射。在麻醉和手术前、手术期间以及术后的头五天，测量了手术引起的内分泌-代谢反应，以血浆促肾上腺皮质激素（ACTH）、皮质醇、胰岛素、生长激素、环磷酸腺苷（cAMP）、葡萄糖、游离脂肪酸、血β-羟丁酸和累积氮平衡的变化来表示。结果发现，吗啡麻醉可阻断手术期间ACTH、皮质醇、生长激素、cAMP和葡萄糖的升高。然而，在体外循环开始后，只有ACTH、皮质醇以及在较小程度上葡萄糖和胰岛素对葡萄糖的反应因吗啡麻醉而降低。在术后第一天至第五天，两组之间在任何参数上均无差异。两组的累积氮平衡相似。结论是，在皮肤切口前给予大剂量吗啡可抑制心脏直视手术最初的内分泌-代谢反应，但这种作用是短暂的，且对术后总体蛋白质分解代谢无影响。
