Kleinschmidt S, Mertzlufft F
Klinik für Anaesthesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg/Saar.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1995 Nov;30(7):393-402. doi: 10.1055/s-2007-996516.
Gamma-hydroxybutyric acid (GHB) as a natural component of the mammalian brain was first introduced in clinical anaesthetic practice more than 30 years ago. Although GHB induced a reliable state of sedation and anaesthesia without depressing either respiratory or cardiocirculatory parameters or liver and kidney function, the drug was nearly displaced from clinical practice because of its prolonged duration of action. The results of recent clinical studies indicate a re-evaluation of GHB in emergency and critical care medicine. GHB is regarded as a natural neuronal transmitter with circuits which synthesise, accumulate and release GHB. Specific binding sites have also been demonstrated and identified. GHB is completely metabolized in the liver to the natural substrates carbon dioxide and water without accumulation in central or peripheral tissues. The reduction of energy metabolism and its possible properties as an "oxygen radical scavenger" may be of therapeutic benefit if tissues are exposed to hypoxia or reperfusion. Therefore, the application of GHB seems to be of advantage in states of traumatic brain injury with cerebral oedema or ischaemic lesions of brain or extraneural tissues. In hypovolaemic states or in patients with impaired cardiovascular function, the pressure effects of GHB may be beneficial for the prevention of tissue damage and may improve survival in the case of cardiocirculatory resuscitation. In the intensive care unit, GHB might be a favourable alternative to established sedative agents. Occurrence of side effects such as tolerance and withdrawal syndromes after the application of sedative drugs, an impaired metabolism with the accumulation of metabolites in the case of liver or kidney dysfunction as well as an insufficient regulation of natural sleep may be diminished by the application of GHB. The results of various clinical studies also suggest that GHB may be useful in the treatment of alcohol and opiate withdrawal syndrome. However, further studies are necessary to specify the proposed indications of GHB in anaesthesiology and critical care medicine.
γ-羟基丁酸（GHB）作为哺乳动物大脑的一种天然成分，早在30多年前就首次被引入临床麻醉实践。尽管GHB能诱导出可靠的镇静和麻醉状态，且不抑制呼吸、心血管参数以及肝肾功能，但由于其作用时间较长，该药物几乎从临床实践中被淘汰。近期临床研究结果表明，需对GHB在急诊和重症医学中的应用进行重新评估。GHB被视为一种天然神经递质，存在合成、积累和释放GHB的神经回路。特定的结合位点也已得到证实和鉴定。GHB在肝脏中完全代谢为天然底物二氧化碳和水，不会在中枢或外周组织中蓄积。如果组织暴露于缺氧或再灌注状态，能量代谢的降低及其作为“氧自由基清除剂”的可能特性可能具有治疗益处。因此，GHB的应用似乎有利于治疗伴有脑水肿的创伤性脑损伤状态或脑及神经外组织的缺血性病变。在低血容量状态或心血管功能受损的患者中，GHB的压力效应可能有利于预防组织损伤，并可能改善心肺复苏时的生存率。在重症监护病房，GHB可能是现有镇静药物的一种良好替代品。应用镇静药物后出现的耐受性和戒断综合征等副作用、肝肾功能不全时代谢受损及代谢产物蓄积，以及自然睡眠调节不足等情况，可能会因应用GHB而减少。各种临床研究结果还表明，GHB可能有助于治疗酒精和阿片类药物戒断综合征。然而，需要进一步研究来明确GHB在麻醉学和重症医学中拟用适应症。
