(肠系膜牵引综合症在腹主动脉动脉瘤的操作——组胺释放和预防与抗组胺剂)。
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杜达维,我洛伦茨W,侯赛因
(肠系膜牵引综合症在腹主动脉动脉瘤的操作——组胺释放和预防与抗组胺剂)。
Anaesthesiol Reanim。2003; 28 (4): 97 - 103。
- PubMed ID
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14528656 (在PubMed]
- 文摘
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肠系膜牵引综合征发生在腹部手术,被描述为突然心动过速、低血压和冲洗。其他病因学因素,eventeration或小肠肠系膜牵引可能导致从肠系膜肥大细胞组胺释放。因此,我们的假设是,肠系膜牵引综合症可能是积极影响H1 -和H2-antihistamines预防性管理。17岁男性病人(ASA组III-V 48 - 78岁)进行了随机双盲研究期间选修腹主动脉瘤(AAA)修理;在我们看来,是一种最标准化的外科手术。八个病人pre-anaesthetic预防和0.1毫克/公斤BW dimetindene (H1-receptor拮抗剂)+ 5毫克/公斤BW西咪替丁(H2-receptor拮抗剂)稀释100毫升0.9%的氯化钠,而9患者接受安慰剂(100毫升0.9%氯化钠)。麻醉和入侵所有患者血流动力学监测是标准化。血流动力学参数,血浆组胺浓度和临床症状测定皮肤切口(HS),后一分钟和5,肠系膜牵引后20分钟(5 EV和20的EV)。统计分析使用学生的学习任务,连续数据和Chi2-test Mann-Whitney-U-test发生率。组胺释放的发病率在安慰剂组为55.5%(5/9)和37.5%(3/8)的抗组胺剂组(p > 0.05, Chi2-test)。 Plasma histamine levels (mean +/- SD) were higher in the placebo group than in the antihistamine group at 5 and 20 min after mesenteric traction, but there was no statistical significance. 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 the groups (e.g. 5 min after mesenteric traction, mean +/- SD; placebo 111 +/- 20 mm Hg vs. antihistamines 119 +/- 35 mm Hg). In the placebo group, however, 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 vs. antihistamine group = 8 times (p = 0.001, Chi2-test). From these results we conclude that prophylactic administration of antihistamines reduces in particular the incidence of arrhythmias and the number of stabilising measures during mesenteric traction. Prophylaxis with H1- and H2-antihistamines may therefore be of perioperative benefit and should be considered in AAA surgery.