腹主动脉瘤手术期间肠系膜牵引综合征组胺释放:H1和H2抗组胺药的预防作用。
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Duda D, Lorenz W, Celik I
腹主动脉瘤手术期间肠系膜牵引综合征组胺释放:H1和H2抗组胺药的预防作用。
中华医学杂志，2002;32(3):391 - 391。doi: 10.1007 / pl00012418。
- PubMed ID
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12477078 (PubMed视图]
- 摘要
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目的和设计:肠系膜牵引综合征被描述为突发性心动过速、低血压和潮红。除其他病因外，肠内穿刺或肠系膜牵引可引起肠系膜肥大细胞释放组胺。我们假设肠系膜牵引综合征可能受到预防性抗组胺药的积极影响。方法:选择腹主动脉瘤(AAA)择期修复术中的男性患者(n = 17, ASA III-IV组，48-78岁)进行随机双盲研究。8例患者麻醉前预防使用二美丁尼(h1受体拮抗剂)加西咪替丁(h2受体拮抗剂)，9例患者使用安慰剂。所有患者麻醉和有创血流动力学监测均标准化。分别于皮肤切开后1 min、肠系膜牵引后5 min、20 min测定血流动力学参数、血浆组胺浓度及临床症状。统计分析采用Student's t检验，发生率采用chi2检验，连续数据采用mann - whitney - u检验。结果:安慰剂组组胺释放率为55.5%(5/9)，抗组胺组为37.5% (3/8)(p < 0.05, ch2检验)。在肠系膜牵引后5和20 min，安慰剂组血浆组胺水平(平均+/- SD)高于抗组胺组，但差异无统计学意义。 Arrhythmias were significantly more frequent in the placebo group (6 times) than in the antihistamine group (none) (p = 0.005 Chi2-test). Systolic blood pressure was not statistically different between groups (e.g. 5 min after mesenteric traction, mean +/- SD; placebo 111 +/- 20 mm Hg vs. antihistamines 119 +/- 35 mm Hg). However, in the placebo group the haemodynamics only stabilised 5 min after mesenteric traction when anaesthetic gas concentration was repeatedly reduced and vasopressor/volume administration was increased (placebo-group = 20 times/antihistamine-group = 8 times, p = 0.001, t-test). CONCLUSION: Prophylactic administration of antihistamines reduced the incidence of histamine release as well as the incidence of arrhythmias and the amount of stabilising measures during mesenteric traction. Prophylaxis with H1 and H2 antihistamines may be of perioperative benefit and should therefore be considered in AAA-surgery.