Heropoulos M, Schieren H, Seltzer J L, Bartkowski R R, Lessin J, Torjman M, Moody C, Goldberg M E
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
Anesth Analg. 1995 Mar;80(3):583-90. doi: 10.1097/00000539-199503000-00027.
This study was designed to evaluate effects of enalaprilat, an angiotensin-converting enzyme inhibitor, on hemodynamic and hormonal responses during surgery at endotracheal intubation, incision, and limb-tourniquet inflation. Thirty patients undergoing limb procedures with general anesthesia (N2O/narcotic technique) and a pneumatic tourniquet were randomized to receive either preoperative enalaprilat (1.25 mg intravenously [i.v.] 20 min prior to induction) or intraoperative enalaprilat (0.625 mg i.v. at the onset of tourniquet-associated hypertension), with appropriate placebo controls. Arterial blood pressure and heart rate increased significantly in response to intubation in the placebo group. Although there were no significant differences in catecholamine levels, plasma renin activity was significantly increased at postincision in the preoperative-enalaprilat group versus the placebo group. This suggests that activation of the renin-angiotensin system may play a key role in mediation of intraoperative hemodynamic responses to endotracheal intubation. With respect to tourniquet hypertension, preoperative or intraoperative treatment with enalaprilat reduced neither the pressor response to tourniquet inflation nor the amount of enflurane subsequently required to control arterial blood pressure. These findings suggest that this response is mediated by pain pathways, and may be treated more effectively with anesthesia/analgesia.
本研究旨在评估血管紧张素转换酶抑制剂依那普利拉在气管插管、手术切口和肢体止血带充气手术过程中对血流动力学和激素反应的影响。30例接受全身麻醉（N2O/麻醉技术）和使用气动止血带进行肢体手术的患者被随机分为两组，一组在诱导前20分钟静脉注射依那普利拉（1.25毫克），另一组在止血带相关高血压发作时静脉注射依那普利拉（0.625毫克），并设置适当的安慰剂对照。安慰剂组在气管插管后动脉血压和心率显著升高。尽管儿茶酚胺水平无显著差异，但术前使用依那普利拉组与安慰剂组相比，术后切口时血浆肾素活性显著升高。这表明肾素 - 血管紧张素系统的激活可能在介导术中对气管插管的血流动力学反应中起关键作用。关于止血带高血压，术前或术中使用依那普利拉治疗既不能降低对止血带充气的升压反应，也不能减少随后控制动脉血压所需的恩氟烷用量。这些发现表明，这种反应是由疼痛通路介导的，可能通过麻醉/镇痛更有效地治疗。
