Engquist A, Blichert-Toft M, Olgaard K, Brandt M R, Kehlet H
Br J Surg. 1978 Apr;65(4):224-7. doi: 10.1002/bjs.1800650403.
The renin-angiotensin system, ACTH and hyperkalaemia are known to induce increased plasma levels of aldosterone. In order to assess the relative significance of these mechanisms during surgical stress, aldosterone, cortisol and electrolytes in plasma were measured in 12 otherwise healthy women during and after cholecystectomy. The patients received either isotonic sodium chloride or 5 per cent glucose in water during the experimental period of 22 h. The results showed that the pronounced increase of aldosterone and the concomitant decrease of sodium in plasma found in patients given glucose in water could almost be inhibited by the administration of saline. Cortisol and potassium concentrations were identical in the two groups of subjects. It is concluded that the aldosterone response to surgery is mainly mediated via the renin-angiotensin system. This response is probably due to a reduced sodium content or volume of extracellular fluid, since it could almost be inhibited by administration of sodium chloride. The rationale of saline restriction during and after surgery is questioned.
已知肾素 - 血管紧张素系统、促肾上腺皮质激素（ACTH）和高钾血症可导致血浆醛固酮水平升高。为了评估手术应激期间这些机制的相对重要性，对12名其他方面健康的女性在胆囊切除术中及术后测定了血浆中的醛固酮、皮质醇和电解质。在22小时的实验期间，患者接受等渗氯化钠溶液或5%葡萄糖溶液。结果显示，接受葡萄糖溶液的患者血浆中醛固酮显著增加且钠含量随之降低，而给予生理盐水几乎可抑制这种变化。两组受试者的皮质醇和钾浓度相同。得出的结论是，手术时醛固酮反应主要通过肾素 - 血管紧张素系统介导。这种反应可能是由于细胞外液钠含量或容量减少所致，因为给予氯化钠几乎可抑制该反应。对手术期间及术后限制生理盐水的基本原理提出了质疑。
