Diago M C, Amado J A, Salas E, López-Cordovilla J J
Departamento de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander.
Rev Esp Anestesiol Reanim. 1993 Jul-Aug;40(4):196-200.
To study the response of the hypothalamic-hypophysial-adrenal axis during heart surgery under anesthesia with diazepam-fentanyl (D-F) at high doses.
We studied the intraoperative response of cortisol, ACTH, and 11-deoxycortisol and aldosterone (RIA) to heart surgery under anesthesia with 0.5 mg/kg diazepam and 0.1 mg/kg fentanyl in 12 patients (group D-F) and the effect on that response of blocking peripheral cortisol production with etomidate (0.15 mg/kg bolus) (group D-F-E, n = 12).
Sharp drops in cortisol, ACTH and 11-deoxycortisol levels were observed in group D-F before the start of extracorporeal circulation (ECC). Albumin and red blood cell counts fell less sharply than did hormone levels. ACTH levels increased after ECC. Throughout surgery, ACTH and cortisol never rose over preanesthetic levels. The response in group D-F-E was similar, with a clear early rise in 11-deoxycortisol and a later rise in ACTH.
Anesthesia with D-F lowers levels in the hypothalamic-hypophysial-adrenal axis below baseline in the phase before ECC, despite the stimulus of surgery and the effect of hemodilution. After ECC, ACTH levels rise. The response seen in group D-F-E suggests that levels in the hypothalamic-hypophysial-adrenal axis are below normal, but that the mechanism is functioning appropriately.
研究在高剂量地西泮-芬太尼（D-F）麻醉下心脏手术期间下丘脑-垂体-肾上腺轴的反应。
我们研究了12例患者（D-F组）在0.5mg/kg地西泮和0.1mg/kg芬太尼麻醉下心脏手术时皮质醇、促肾上腺皮质激素（ACTH）、11-脱氧皮质醇和醛固酮（放射免疫分析法）的术中反应，以及依托咪酯（0.15mg/kg静脉推注）阻断外周皮质醇生成对该反应的影响（D-F-E组，n = 12）。
D-F组在体外循环（ECC）开始前观察到皮质醇、ACTH和11-脱氧皮质醇水平急剧下降。白蛋白和红细胞计数下降幅度小于激素水平。ECC后ACTH水平升高。在整个手术过程中，ACTH和皮质醇从未超过麻醉前水平。D-F-E组的反应相似，11-脱氧皮质醇明显早期升高，ACTH随后升高。
尽管有手术刺激和血液稀释的影响，但在ECC前阶段，D-F麻醉会使下丘脑-垂体-肾上腺轴水平降至基线以下。ECC后，ACTH水平升高。D-F-E组所见反应表明下丘脑-垂体-肾上腺轴水平低于正常，但该机制功能正常。
