Spapen H, Diltoer M, Nguyen D N, Ingels G, Ramet J, Huyghens L
Intensive Care Department, Academic Hospital, Vrije Universiteit Brussel, Belgium.
Acta Anaesthesiol Belg. 1995;46(3-4):133-40.
Cimetidine is commonly used for stress ulcer prophylaxis in intensive care patients. Cimetidine contains an imidazole structure. Similar drugs have been shown to inhibit steroid synthesis by blocking cytochrome P450-dependent reactions in the adrenal cortex. It is suggested that bolus injections of cimetidine suppress the normal corticosteroid production. This might be deleterious since a decreased cortisol response seems to be associated with increased mortality during chronic severe stress. We therefore performed a prospective, randomized, and controlled study to assess the effect of a short-term continuous infusion of either cimetidine or ranitidine, a non-imidazole H2-pantagonist, upon cortisol secretion in a cohort of hemodynamically stable intensive care patients. Twenty patients were consecutively enrolled following determined inclusion criteria and divided in three treatment groups: 6 controls, 7 cimetidine- and 7 ranitidinetreated subjects. Both cimetidine (1200 mg) and ranitidine (200 mg) were administered by infusion pump over 24 hrs. A short corticotropin test was done within 24 hrs after admission (d0) and repeated 7 days thereafter (d7). On both occasions, plasma cortisol was measured immediately before the test and 30 min afterwards. The three treatment groups presented a normal cortisol response at d0 and d7. Peak cortisol levels after stimulation did not show any significant difference for both the cimetidine and the ranitidine group, either at d0 or at d7. Moreover, this response at d0 and d7 was also not significantly different from the one observed in the controls. From this study we can conclude that one week treatment with conventional intravenous doses of cimetidine does not induce significant alterations of the cortisol response in hemodynamically stable ICU patients.
西咪替丁常用于重症监护患者的应激性溃疡预防。西咪替丁含有咪唑结构。已表明类似药物可通过阻断肾上腺皮质中细胞色素P450依赖性反应来抑制类固醇合成。有人认为静脉推注西咪替丁会抑制正常的皮质类固醇生成。这可能是有害的，因为在慢性严重应激期间，皮质醇反应降低似乎与死亡率增加有关。因此，我们进行了一项前瞻性、随机对照研究，以评估短期持续输注西咪替丁或雷尼替丁（一种非咪唑类H2拮抗剂）对一组血流动力学稳定的重症监护患者皮质醇分泌的影响。按照确定的纳入标准连续招募了20名患者，并将其分为三个治疗组：6名对照组、7名接受西咪替丁治疗的患者和7名接受雷尼替丁治疗的患者。西咪替丁（1200毫克）和雷尼替丁（200毫克）均通过输液泵在24小时内给药。入院后24小时内（d0）进行一次短促肾上腺皮质激素试验，并在7天后（d7）重复进行。在这两个时间点，均在试验前及试验后30分钟立即测量血浆皮质醇。三个治疗组在d0和d7时的皮质醇反应均正常。在d0或d7时，西咪替丁组和雷尼替丁组刺激后的皮质醇峰值水平均无显著差异。此外，d0和d7时的这种反应与对照组观察到的反应也无显著差异。从这项研究我们可以得出结论，对于血流动力学稳定的重症监护病房患者，用常规静脉剂量的西咪替丁治疗一周不会引起皮质醇反应的显著改变。
