Lorenz W, Duda D, Dick W, Sitter H, Doenicke A, Black A, Weber D, Menke H, Stinner B, Junginger T
Institute of Theoretical Surgery, Phillips University, Marburg, Germany.
Lancet. 1994 Apr 16;343(8903):933-40. doi: 10.1016/s0140-6736(94)90063-9.
Although histamine release is recognised as a common event during anaesthesia and surgery, few clinicians judge the resultant cardiorespiratory disturbances serious enough to warrant prophylaxis with antihistamines. We have assessed the incidence and importance of histamine release in a randomised 2 x 2 factorial study. 240 patients representing a routine throughput of major general surgery were studied during a standardised induction of anaesthesia and preoperative loading of the circulation with either Ringer solution or Haemaccel-35, with or without antihistamine prophylaxis with dimetindene (H1) plus cimetidine (H2). Cardiorespiratory disturbances were graded as detectable, clinically relevant, or life-threatening from observers' records of the anaesthesia and the actions taken by the anaesthetists. Disturbances that were accompanied by significant rises in plasma histamine were further designated histamine-related, and those that were not were designated histamine-unrelated. Anaesthetists, observers, and designators were blinded to whether or not the patients had received antihistamines and to which solution was used for circulatory volume loading. Clinically relevant or life-threatening histamine-related disturbances occurred in 8% of the patients who after induction of anaesthesia received Ringer without antihistamines, in 26% of those who received Haemaccel without antihistamines, and in 2% or less of those who received antihistamines (p < or = 0.0001). There were 4 life-threatening histamine-related disturbances, all in patients who received Haemaccel without antihistamines (p < 0.01). Histamine-unrelated disturbances occurred in 16% overall, with no obvious effect of Haemaccel or antihistamines. The histamine-related disturbances under anaesthesia were remarkable for their severity (even with small rises in histamine concentrations), for the prevalence of bradycardia, and for the absence of skin signs. Their likelihood and severity were increased in patients with tumours. The results of the trial make a case for routine prophylaxis with antihistamines as part of anaesthetic management.
尽管组胺释放被认为是麻醉和手术过程中的常见现象，但很少有临床医生认为由此产生的心肺功能紊乱严重到足以使用抗组胺药进行预防。我们在一项随机2×2析因研究中评估了组胺释放的发生率和重要性。对240例代表普通外科常规手术量的患者进行了研究，在标准化麻醉诱导和术前循环负荷时，分别使用林格溶液或贺斯 - 35，同时给予或不给予用二甲茚定（H1）加西咪替丁（H2）进行抗组胺预防。根据麻醉记录和麻醉医生采取的措施，将心肺功能紊乱分为可检测到的、临床相关的或危及生命的。伴有血浆组胺显著升高的紊乱被进一步指定为组胺相关的，而未升高的则被指定为组胺无关的。麻醉医生、观察者和指定人员对患者是否接受抗组胺药以及用于循环容量负荷的溶液种类均不知情。在麻醉诱导后接受林格溶液且未使用抗组胺药的患者中，8%发生了临床相关或危及生命的组胺相关紊乱；在接受贺斯且未使用抗组胺药的患者中，这一比例为26%；而在接受抗组胺药的患者中，这一比例为2%或更低（p≤0.0001）。有4例危及生命的组胺相关紊乱，均发生在接受贺斯且未使用抗组胺药的患者中（p<0.01）。组胺无关的紊乱总体发生率为16%，贺斯或抗组胺药对此无明显影响。麻醉期间的组胺相关紊乱以其严重程度（即使组胺浓度略有升高）、心动过缓的发生率以及无皮肤症状为显著特征。肿瘤患者中其发生可能性和严重程度增加。该试验结果支持将抗组胺药常规预防作为麻醉管理的一部分。
