氯胺酮-安定静脉麻醉下小儿手术时的内分泌功能变化

检侧了２０例小儿手术期间肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡｇⅡ）。醛固酮（ＡＬＤ）及皮质醇（ＣＯＲ）的变化。氯胺酮 安定静脉麻醉下，分别于麻醉前、麻醉后２０ｍｉｎ，切皮后５ｍｉｎ，３０ｍｉｎ及术后１ｈ，２４ｈ分取５ｍｌ静脉血，检测ＰＲＡ，ＡｇⅡ，ＡＬＤ，ＣＯＲ含量的变化。结果：麻醉后２０ｍｉｎ的ＣＯＲ值较对照值增高（Ｐ＜００５）切皮后５ｍｉｎ，３０ｍｉｎ和６０ｍｉｎ的ＡＬｄ，Ｃｏｒ值均较对照值有显著性增高（Ｐ＜００５或＜００１），且切皮后５ｍｉｎ，３０ｍｉｎ和６０ｍｉｎＡＬＤ，ＣＯＲ值均明显高于麻醉后２０ｍｉｎ值（Ｐ＜００１）。直至手术后２４ｈ时的ＡＬＤ值仍分别较对照值和麻醉后２０ｍｉｎ值有高度显著性（Ｐ＜００１）。提示本麻醉法不能阻止手术的伤害性剌激，引起应激效应激素的分泌过度增加。

The Effects of Intravenous Anesthesia with Ketamine and Diazepam on the Endocrine Function of Postoperative Children.

Objective: The endocrine function changes were observed in postoperative children after intravenous anesthesia with ketamine and diazepam to find out if it ishyperreactive or hypoteactive of the stress hormones such as plasmarenin(PRA), angiotensin Ⅱ(AgⅡ), aldosterone, ALD, and cortisol (COR) to raise the clinical signifivcance. Method: Venous blood samples (5 ml) of 20 children under short minor operation of ASA I degree were taken before operation, 20 minutes after anesthesia, 5,30, 60 minutes after skin incision and 24 hours after operation to deferminethe perioperative plasma levels of PRA, AgⅡ, ALD and COR. Results:No statistical significance was found in changes of PRA and AgⅡ levels which are relatively high, but it was found that the COR coneentration was increased after aneathesia, AbI, COR were markedly increased after skin incision, the level of ALD and CoR after skin incision were much higher than that after anesthesia. Conclusion: This anesthetsia procedure cannot stop the afference of the nocuous stimulation from the operative field to the central nervous system which can lead to the secretion of COR and ALD in large quantity. These reactions have relevance to the postoperative imbalance of immunosuppression and metabolism of water electrolyte, sugar and protein which are harmful to children's body.