不同麻醉法对血浆肾素,血管紧张素II,醛固酮,皮质醇水平的…

观察全麻复合硬膜外阻滞和全麻两种麻醉时血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇变化。２５例择期上腹部手术患者，随机分两组：Ａ组为全麻复合硬膜外阻滞１２例，Ｂ组为全麻１３例。分别于麻醉前、麻醉插管后２分钟、进腹探查时、术中２小时、拔管后即刻抽取中心静脉血测肾素、血管紧张素Ⅱ、醛固酮、皮质醇的浓度。结果示Ａ组麻醉前后无明显变化（Ｐ〉０．０５）；Ｂ组术中肾素活性和皮质醇显著增高（Ｐ〈０．０１）。此外，手术     

不同麻醉法对血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇水平的影响

观察全麻复合硬膜外阻滞和全麻两种麻醉时血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇变化。２５例择期上腹部手术患者，随机分两组：Ａ组为全麻复合硬膜外阻滞１２例，Ｂ组为全麻１３例。分别于麻醉前、麻醉插管后２分钟、进腹探查时、术中２小时、拔管后即刻抽取中心静脉血测肾素、血管紧张素Ⅱ、醛固酮、皮质醇的浓度。结果示Ａ组麻醉前后无明显变化（Ｐ＞０．０５）；Ｂ组术中肾素活性和皮质醇显著增高（Ｐ＜０．０１）。此外，手术期间Ａ组比Ｂ组心率慢，血压低（Ｐ＜０．０１）。表明全麻复合硬膜外阻滞是一种应激反应较轻的麻醉方法。     

地氟醚对手术病人肾素—血管紧张素—醛固酮系统及皮质醇的影响

目的 观察地氟醚在手术中对肾素-血管紧张素-醛固酮系统（RAAS）及皮质醇的影响。方法 选择30例择期在全麻下实施上腹部手术病人，随机分为地氟醚组和安氟醚组，每组15例。术中分五个时点采集静脉血，以放免法测定血浆肾素活性（PRA）、血管紧张素Ⅱ（AⅡ）、醛固酮（Al）及皮质醇（Cor）。结果 地氟醚组在切皮时即出现PRA、AⅡ、Al的升高，尤以Al显著，术中继续升高。两组Cor术中均升高，但无明显组间差异。地氟醚组中血压及心率增加明显。结论 地氟醚可早期激活RAAS，并有交感兴奋作用；但不能抑制手术刺激引起的Cor升高。     

心肺转流患者围手术期ANF及RAAS的变化

对１６例ＣＰＢ手术患者手术期间血浆心钠素（ＡＮＦ），肾素，血管紧张素Ⅱ，醛固酮的动态观察，发现血浆肾素于ＣＰＢ期间逐渐升高，术终及术后２４小时显著高于诱导前（Ｐ〈０．０５和Ｐ〈０．０１），血管紧张素Ⅱ于ＣＰＢ开始时降低，后逐渐升高，术终明显高于诱导前（Ｐ〈０．０５），血浆ＡＮＦ变化趋势与血管紧张素Ⅱ类似；平均动脉压与血浆肾素，血管紧张素Ⅱ及ＡＮＦ均呈正相关。推测ＲＡＡＳ与ＡＮＦ在维持血容量及外周…     

微通道经皮肾镜取石术中灌注液吸收对机体影响的研究

目的 通过对微通道经皮肾镜取石术(mPNL)手术前后血流动力学、血生化和相关激素的监测,探讨mPNL术中灌注液吸收对机体的影响.方法 2007年1月至2008年2月对128例肾结石或输尿管上段结石患者实施了mPNL.手术前后监测血红蛋白、红细胞压积、血浆渗透压、血电解质、血肌酐及肾素、血管紧张素Ⅱ和醛固酮.术中每30 min动态记录心率、平均动脉压和外周血氧饱和度的变化.结果 术中患者的心率随着灌注时间延长而加快.术毕血浆渗透压、血清Cl-、肾素和血肌酐较术前增高.术毕血红蛋白、红细胞压积、血清K+较术前降低.平均动脉压、外周血氧饱和度、血清Na+、醛固酮和血管紧张素Ⅱ手术前后无明显变化.所有患者无严重并发症发生.结论 mPNL术中液体吸收的量与灌注时间呈正相关.一定量的液体吸收可引起患者血流动力学、血生化及血肾素的变化.     

不同全麻诱导药对高血压病人围诱导期血浆R-A-A-S系统的影响

在全身动脉血压的调节中,肾素-血管紧张素-醛固酮系统（Renin-angiotensin-aldosterone system,R-A-A-S）具有非常关键性的作用,围手术期对血浆肾素活性（Plasmarenin activity,PRA）、血管紧张素 Ⅱ（angiotensin Ⅱ,A Ⅱ）和醛固酮（aldosterone,Ald）系统的研究较多[1,2],本研究旨在观察不同全麻诱导药对原发性高血压病人围诱导期血     

氯胺酮,安氟醚麻醉对子宫切除术患者血浆心钠素,肾素,血管紧…

本文研究了氯胺酮、安氟醚麻醉对子宫肌瘤切除术患者血浆心钠素（ＡＮＰ）、肾素（ＰＲＡ）、血管紧张素（ＡⅡ）和醛固酮（ＡＬ）水平的影响。通过１５例子宫肌瘤切除术患者的临床观察，结果表明，子宫肌瘤手术患者氯胺酮、安氟醚麻醉后１０ｍｉｎ、３０ｍｉｎ、１ｈ和术毕ＡＮＰ显著高于麻醉前；ＰＲＡ与麻醉前比较有升高趋势；ＡⅡ在麻醉后３０ｍｉｎ至术毕低于麻醉前；血浆ＡＬ自麻醉后１０ｍｉｎ开始升高，至麻醉后１ｈ和术毕非     

硬膜外阻滞下上复中手术病人围手术期血浆ACTH 皮质醇醛固…

对１５例择期上腹部手术患者在硬膜外阻滞下围手术期血浆ＡＣＴＨ，皮质醇，醛固酮的变化进行了观察，结果表明在麻醉前后三种激素值无明显差异顺手术６０ｍｉｎ时均明显升高，与麻醉前值相比较有显著性差异，术毕６０ｍｉｎ时ＡＣＴＨ和皮质醇值仍有显著性差异。     

硬膜外阻滞和N_2O-O_2-安氟醚吸入麻醉对围术期老年男性R-A-A系统的影响

２０例择期行前列腺摘除或膀胱肿瘤部分切除病人，随机分为两组，每组１０例，分别行硬膜外麻醉（双管法）和氧化亚氮－氧气－安氟醚（ＧＯＥ）吸入麻醉，测定麻醉和手术过程中血浆肾素活性，血管紧张素Ⅱ（ＡⅡ）和醛固酮（Ａｌｄ）浓度的变化，并进行比较。结果：硬膜外组病人的三者浓度在麻醉和手术过程中无明显变化，而ＧＯＥ组麻醉和手术使ＲＡＡ浓度显著升高，两组差异高度显著。结论：双管法硬膜外阻滞可消除盆腔手术病人手术引起的肾素、血管紧张素和醛固酮反应，而ＧＯＥ吸入麻醉却无这方面作用。     

婴幼儿室间隔缺损并肺动脉高压行直视修补术后肾素—血管紧…

将２６例婴幼儿室间隔缺损患儿依肺动脉压力高低分成四组，测定术前及术后５天内不同时点血浆肾素活性，血管紧张素和醛固酮水平。结果发现，术后所有患儿的血浆ＰＲＡ，ＡＩＩ和Ａｌｄ均明显高于健康组。术后５天内对照组和轻度肺动脉高压组肾素－血管紧张 －醛固酮系统降至低于术前水平；中度肺动脉组术后ＡＩＩ持续升高，术后第５天仍处于高水平     

Vasoactive modulators during and after craniotomy: relation to postoperative hypertension

Hypertension after craniotomy is frequent. To establish an association between vasoactive modulators and postoperative hypertension, we followed the arterial blood pressure and plasma concentrations of selected substances in patients undergoing craniotomy. Twelve consecutive patients scheduled for operation of a supratentorial brain tumor were anesthetized with thiopental, fentanyl, isoflurane, and pancuronium. None of the patients had a history of arterial hypertension or were hypertensive before the operation. Arterial blood pressure and heart rate measurements were obtained preoperatively, after incision, during closure, and four times in the 50-minute interval after stopping isoflurane. At the same time, plasma concentrations of norepinephrine, epinephrine, renin, aldosterone, atrial natriuretic peptide, endothelin, and cortisol were measured. Data are given as mean +/- SD (range). The postoperative concentrations of these substances were significantly higher than the baseline concentrations measured preoperatively. Six of the patients developed postoperative hypertension defined as a mean arterial pressure (MAP) > 20% more than the baseline MAP (group H), and six had normal blood pressure postoperatively (group N). The mean value of the maximal postoperative MAPs measured in groups H and N, respectively, was 118 +/- 16 mm Hg (range: 96-132) and 103 +/- 9 mm Hg (range: 92-115) (P =.01). Only renin levels were higher intraoperatively in group H when compared to group N. However, postoperative levels of catecholamines, aldosterone, renin, and endothelin levels were higher in group H patients. The results suggest that in addition to an increased discharge of the sympathetic system, activation of the renin-angiotensin aldosterone system may also play an important role in the development of postoperative hypertension after craniotomy.     

Pituitary-adrenocortical response to surgical stress in male patients

Effects of major surgical stress on the plasma levels of twelve kinds of steroid hormones, ACTH and renin activity, and on the excretion rates of urinary free cortisol and acid labile aldosterone etc. were studied in eleven male patients for seven days following operation. In another groups of patients, ACTH tests were carried out in order to investigate the effect of ACTH on the adrenal steroid hormone production. Also, an in vitro assay of the effect of ACTH on the adrenal tissue was performed. Surgical stress provoked marked increase in plasma levels of cortisol, despite little change in aldosterone levels. The postoperative plasma testosterone concentration showed a profound decrease throughout the observation period. The plasma renin activity reached the highest level on the first postoperative day, when plasma aldosterone was at the lowest level. It was concluded that the postoperative changes in the plasma steroid hormone levels were markedly influenced by other physical and humoral disorders provoked with surgical stress.     

Endocrine response to surgical stress in three patients over 100 yr

PURPOSE: To report the change of plasma epinephrine, norepinephrine, cortisol, plasma renin activity, plasma aldosterone and plasma atrial natriuretic peptide during general anesthesia in three centenarian patients. CLINICAL FEATURES: Three patients aged 101, 101 and 102-yr, underwent a screw fixation of femoral fracture under general anesthesia. Plasma concentrations of epinephrine, norepinephrine, cortisol, renin activity, aldosterone and atrial natriuretic peptide were measured before the induction of anesthesia, 15 min after incision and 60 min after the end of surgery. Plasma epinephrine concentrations in the three patients increased from 419, 344 and 377 pg x ml(-1) before anesthesia to 688, 534 and 478 pg x ml(-1) 15 min after skin incision. Plasma norepinephrine concentrations increased markedly from 408, 513 and 606 pg x ml(-1) before anesthesia to 2950, 1864 and 1574 pg x ml(-1) 15 min after skin incision. The cortisol response to surgery was similar to that of young adults. Plasma aldosterone and renin activity was low throughout anesthesia. Plasma atrial natriuretic peptide increased from 353, 367 and 109 pg x ml(-1) before induction to 479, 487 and 168 pg x ml(-1) 15 min after skin incision. CONCLUSION: Plasma norepinephrine concentration in patients over 100 yr increased markedly during anesthesia, while plasma renin activity and aldosterone were lower.     

A comparison of the endocrine effects of hypotension induced by nicardipine with those by sodium nitroprusside in dogs

Plasma catecholamines, plasma renin activity, plasma aldosterone and plasma cortisol during hypotension induced by sodium nitroprusside and nicardipine were studied in 27 mongrel dogs under 0.87% halothane in oxygen. They were randomly divided into three groups: sodium nitroprusside (group S: n = 8), nicardipine (group N: n = 8) and controls (group C: n = 9). Group C received no vasodilator therapy and served as a control. Mean arterial pressure was reduced and maintained at 60 mmHg for 60 minutes in hypotensive groups. No changes were noted in plasma catecholamines and plasma cortisol in group C throughout the experiment, but plasma renin activity and plasma aldosterone decreased progressively. During hypotension induced by sodium nitroprusside and nicardipine, plasma epinephrine was significantly higher than the control value. However, after the hypotensive drugs were discontinued, plasma epinephrine decreased slightly. During and after induced hypotension, plasma renin activity of group N and group S were significantly higher than the control values. The highest levels of plasma renin activity 36.7 ng.ml-1.hr-1 in group N and 23.2 ng.ml-1.hr-1 in group S were observed. Plasma aldosterone concentration was significantly higher than the control value in group N. The maximum increase occurred 30 minutes after discontinuation of the nicardipine and the highest concentration of plasma aldosterone was three times control value. In contrast, in group S, plasma aldosterone was unchanged from the control value. Plasma cortisol concentration of group N was significantly increased than the control value. However, in group S, plasma cortisol concentration showed a slight but not significant increase.(ABSTRACT TRUNCATED AT 250 WORDS)     

Change in circulating blood volume following craniotomy

OBJECT: The importance of monitoring circulating blood volume (CBV) during perioperative management is widely recognized in critically ill patients. The purpose of this study was to investigate the change in CBV following craniotomy by using indocyanine-green pulse spectrophotometry. METHODS: Circulating blood volume and plasma hormones related to stress and fluid regulation were measured five times: preoperatively, immediately postoperatively, and 1, 2, and 7 days after craniotomy was performed in 17 patients with a brain tumor or an unruptured aneurysm. The mean value of CBV preoperatively was 82 ml/kg, which decreased to 64 ml/kg (78%) immediately postoperatively and gradually recovered to 82 ml/kg on Day 7 postsurgery (p = 0.0069). The mean values of adrenaline, noradrenaline, arginine vasopressin, renin, and aldosterone were highest immediately postoperatively. The mean intraoperative balances of water and sodium were 1,090 ml and 113 mEq, respectively. Partial correlation coefficients of CBV to noradrenaline and serum sodium during the entire study were -0.430 (p = 0.0036) and 0.418 (p = 0.0048), respectively. CONCLUSIONS: Attention should be paid to decreased CBV following craniotomy, which is caused by the shift of fluid to interstitial spaces due to surgical stress. Hypovolemia can be suspected from a postoperative decrease in serum sodium.     

Plasma renin activity, plasma aldosterone and electrolyte balance in the postoperative period (author's transl)]

Plasma renin-activity and plasma aldosterone were measured by radioimmunoassay in 15 female patients before and 16 hours after intraabdominal surgery. Plasma renin was increased in all patients and plasma aldosterone in 12 patients after operation. Plasma renin and plasma aldosterone were correlated significantly (r=0.66, p less than 0.01) in the whole group. The increase of renin and plasma aldosterone was correlated inversely to urinary sodium-potassium-ratio. In 5 patients the increase of plasma renin and plasma aldosterone could not be prevented by the intra- and postoperative administration of 360 mEq of sodium, which was consequently retained. It is proposed that postoperative hyperaldosteronism is at least partly mediated through the renin-angiotensin-system. An absolute or relative sodium deficit appears to be an unlikely explanation for the stimulation of the renin-angiotensin-system in the postoperative period. The postoperative increase of plasma renin and consequently plasma aldosterone is possibly a consequence of anaesthetic induced impaired kidney perfusion and/or catecholamine mediated stimulation of renin release.     

Laparoscopic cholecystectomy: haemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position

We have assessed the potential for myocardial ischaemia during laparoscopic cholecystectomy in 16 otherwise healthy patients. Continuous ambulatory ECG monitoring was commenced 12 h before operation and continued for 24 h after operation. The neuroendocrine stress response was assessed by measuring plasma concentrations of adrenaline and noradrenaline, human growth hormone, cortisol, renin and aldosterone, and prolactin, at specified times during surgery. Acute ST segment changes in the ECG occurred in only two patients. These episodes were independent of creation of pneumoperitoneum and changes in position. Acute intraoperative increases in MAP were noted during insufflation of carbon dioxide and reverse Trendelenburg positioning (P < 0.05). A four-fold increase in plasma concentrations of renin and aldosterone was noted after pneumoperitoneum and reverse Trendelenburg positioning (P > 0.05). There was a linear correlation between changes in plasma renin and aldosterone concentrations and MAP (r = 0.97 and r = 0.85, respectively). Prolactin concentrations increased four-fold after induction of anaesthesia. Cortisol, HGH, adrenaline and noradrenaline concentrations increased after deflation of the pneumoperitoneum. The time profile-concentration changes of increased MAP and renin-aldosterone suggests a cause-effect relationship. Increased intra-abdominal pressure and reverse Trendelenburg positioning may reduce cardiac output and renal blood flow. The early increase in prolactin concentration was probably secondary to the effect of the opioid fentanyl.      

Plasma renin activity and plasma aldosterone during anaesthesia and operative stress and beta-adrenergic blockade (author's transl)]

In 21 patients undergoing ear operations associated with minimal bleeding plasma renin activity and plasma aldosterone concentration were studied before and during surgical procedure, and in the postoperative state. Studies were performed in two groups, one without (n=9) and one with beta-adrenergic blockade by Practolol (n=12). Plasma renin activity increased significantly during halothane anaesthesia alone whereas the surgical manipulations did not further influence mean values significantly. Thus, it seems to be established that anaesthesia per se influences renin secretion. On the other hand Practolol does not show an inhibiting effect. The plasma renin increase following anaesthesia is due to the hemodynamic including renal hemodynamic, changes as well as to activation of the sympatho-adrenal system. Changes in plasma aldosterone are variable. For the greater part of patients with beta-adrenergic blockade an increase during the operative procedure was found. However, in some patients especially in the control group, plasma aldosterone was unchanged or decreased in spite of increasing renin values. Significantly lower plasma potassium concentration in these cases seems to indicate the important contributing role of potassium for the short-term regulation of aldosterone secretion. Plasma sodium concentration remained unchanged for the periods studied.     

Analysis of postoperative biochemical values and clinical outcomes after adrenalectomy for primary aldosteronism

Background

Primary aldosteronism causes hypertension and hypokalemia and is often surgically treatable. Diagnosis includes elevated plasma aldosterone, suppressed plasma renin activity, and elevated aldosterone renin ratio. Adrenalectomy improves hypertension and hypokalemia. Postoperative plasma aldosterone and plasma renin activity may be useful in documenting cure or failure.

Anterior pituitary, thyroid, parathyroid and adrenal responses to subtotal thyroidectomy in patients with Graves' disease

Changes in the serum levels of anterior pituitary, thyroid, parathyroid, and adrenal hormones following subtotal thyroidectomy in 31 patients with Graves' disease were investigated. In 14 patients, rapid ACTH tests were performed on the preoperative and the first, third, and seventh post-operative days. Remarkable differences were not seen with regard to the changes in anterior pituitary hormones or cortisol, compared to those seen during general surgery. As to the thyroid hormones, the serum level of triiodothyronine (T3) decreased markedly after surgery and fell to half that of the preoperative value on the first postoperative day. Thereafter, a low value of T3 was maintained during the early postoperative period. Unlike T3, the serum level of thyroxine (T4) decreased gradually until the 7th post-operative day. The levels of both epinephrine and norepinephrine increased transiently during surgery, but the serum level of norepinephrine increased again on the third postoperative day. In the postoperative period, almost half the number of patients showed an inadequate cortisol response to rapid ACTH tests. It is suggested that the unique responses, such as the rise in serum norepinephrine or an inadequate response of cortisol to ACTH, or hypocalcemia, after subtotal thyroidectomy in patients with Graves' disease is largely due to the rapid decrease of T3 in the hypothyroid state, as was noted during the postoperative period.