Hypothermic anesthesia attenuates postoperative proteolysis.
Hypothermic anesthesia attenuates postoperative proteolysis.
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低温麻醉减弱术后蛋白水解作用。
DOI：
10.1097/00000658-198610000-00010
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发表时间：
1986
影响因子：
9
通讯作者：
Wilmore,DW
中科院分区：
文献类型：
--
作者：
Johnson,DJ;Brooks,DC;Pressler,VM;Hulton,NR;Colpoys,MF;Smith,RJ;Wilmore,DW
大手术后通常发生的分解代谢反应的特点是骨骼肌蛋白水解和氮排泄加速。在接受与体外循环、麻醉麻醉、神经肌肉阻滞和低温联合治疗相关的心脏外科手术的患者中，这种反应不存在。术后第一天前臂氮释放量为 422 +/- 492 nmol/100 ml X 分钟，约为术前值的 25%（1677 +/- 411，p 小于 0.05）。氮排泄和负氮平衡程度与无压力、禁食受试者中观察到的水平相当。在动物研究中进一步评估了低温、大剂量芬太尼麻醉和神经肌肉阻滞在改变剖腹手术和腹膜后解剖的分解代谢反应中的潜在作用。术后六小时，后躯氨基酸氮释放量比对照值少 84%（p 小于 0.05）。与常温对照相比，氮排泄和尿素产生也减少。结论是，低温、麻醉麻醉和神经肌肉阻滞的结合可以减弱对损伤的分解代谢反应，因此可能有助于危重手术患者的护理。
The catabolic response that commonly occurs after major operation is characterized by net skeletal muscle proteolysis and accelerated nitrogen excretion. This response was absent in patients undergoing cardiac surgical procedures associated with the combination of cardiopulmonary bypass, narcotic anesthesia, neuromuscular blockade, and hypothermia. Forearm nitrogen release was 422 +/- 492 nmol/100 ml X min on the first postoperative day, approximately 25% of preoperative values (1677 +/- 411, p less than 0.05). Nitrogen excretion and the degree of negative nitrogen balance were comparable to levels observed in nonstressed, fasting subjects. The potential role of hypothermia, high-dose fentanyl anesthesia, and neuromuscular blockade in modifying the catabolic response to laparotomy and retroperitoneal dissection was further evaluated in animal studies. Six hours after operation, amino acid nitrogen release from the hindquarter was 84% less than control values (p less than 0.05). Nitrogen excretion and urea production were also reduced compared to normothermic controls. It is concluded that the combination of hypothermia, narcotic anesthesia, and neuromuscular blockade attenuates the catabolic response to injury and thus may be useful in the care of critically ill surgical patients.