Sigurdsson G, Lindahl S, Nordén N
Br J Anaesth. 1982 Oct;54(10):1075-80. doi: 10.1093/bja/54.10.1075.
The endocrine response to stress, as reflected by the plasma concentrations of ACTH and cortisol, was investigated in 14 children receiving two different premedications during halothane anaesthesia for adenoidectomy. Seven children (group A) were premedicated with diazepam 5 mg rectally and atropine 0.3-0.4 mg sublingually and seven (group B) received a rectal combination of diazepam 0.5 mg kg-1, morphine 0.15 mg kg-1 and hyoscine 0.01 mg kg-1. Before and after surgery plasma concentrations of ACTH and cortisol were lower in group B than in group A. In group A mean values for ACTH increased from 40.7 ng line-1 before adenoidectomy to 352.9 ng litre-1 (P less than 0.001) after adenoidectomy. The corresponding increase in group B was from 12.1 ng litre-1 to 82.1 ng litre-1 (P less than 0.01). In group A mean cortisol concentrations increased from 235.7 nmol litre-1 to 655.7 nmol litre-1 after adenoidectomy (P less than 0.01) and in group B from 121.4 nmol litre-1 to 427.9 nmol litre-1 (P less than 0.01). End-tidal carbon dioxide tension was approximately the same in both groups. It was concluded that the combination of diazepam, morphine and hyoscine decreased the endocrine response to stress.
在14名接受腺样体切除术的儿童中，研究了氟烷麻醉期间接受两种不同术前用药时，血浆促肾上腺皮质激素（ACTH）和皮质醇浓度所反映的应激内分泌反应。7名儿童（A组）术前经直肠给予5mg地西泮，舌下给予0.3 - 0.4mg阿托品；另外7名儿童（B组）接受直肠联合用药，剂量为0.5mg/kg地西泮、0.15mg/kg吗啡和0.01mg/kg东莨菪碱。手术前后，B组血浆ACTH和皮质醇浓度均低于A组。A组中，ACTH平均值从腺样体切除术前的40.7ng/升增至术后的352.9ng/升（P<0.001）。B组相应的增幅为从12.1ng/升至82.1ng/升（P<0.01）。A组皮质醇平均浓度从腺样体切除术前的235.7nmol/升增至术后的655.7nmol/升（P<0.01），B组则从121.4nmol/升增至427.9nmol/升（P<0.01）。两组的呼气末二氧化碳分压大致相同。得出的结论是，地西泮、吗啡和东莨菪碱的联合用药降低了对应激的内分泌反应。
