Histamine Release by Four Narcotics: A Double‐Blind Study in Humans
Histamine Release by Four Narcotics: A Double‐Blind Study in Humans
复制标题
四种麻醉剂释放的组胺：人类双盲研究
作者：
J. Flacke;W. Flacke;B. C. Bloor;A. V. Van Etten;B. Kripke
对60例（男28例，女32例）拟在平衡麻醉下进行普通外科手术的成人进行了与四种麻醉药相关的组胺释放和血流动力学变化的研究。在双盲条件下，在硫喷妥钠、琥珀胆碱和插管前，静脉注射递增等效剂量的哌替啶、吗啡、芬太尼或舒芬太尼诱导麻醉。在麻醉剂给药前和给药后1、6和20 min抽取动脉血样本。在16名给予哌替啶（平均剂量4.3 ± 0.2（SEM）mg/kg）的患者中，5名（31%）出现临床体征（低血压、心动过速、红斑），麻醉剂给药后1分钟血浆组胺水平升高，范围为3.2 - 49.7 μg/ml。这5例患者此时的血浆肾上腺素水平也升高。吗啡（0.6 ± 0.02mg/kg）组10例中有1例出现低血压、心动过速，血浆组胺水平升高至12.4ng/ml。芬太尼（7 ± 0.4 μg/kg）或舒芬太尼（1.3 ± 0.1 μg/kg）组均无组胺释放或血浆组胺水平升高。在6例发生组胺释放的患者中，1分钟时的组胺水平与心率、血压和血浆肾上腺素水平的变化幅度之间存在显著相关性。所有6名组胺释放者都是年轻女性，年龄从18岁到35岁不等。哌替啶后组胺的释放比其他麻醉剂（包括吗啡）后更频繁，血流动力学损害的程度与血浆组胺浓度的增加有关。
Histamine release and hemodynamic changes associated with four narcotics were studied in 60 adults (28 men, 32 women) scheduled for general surgery under balanced anesthesia. Under double-blind conditions, incremental eauipotent doses of meperidine, morphine, fentanyl, or sufentanil were administered IV for induction of anesthesia, prior to thiopental, succinylcholine, and intubation. Arterial blood samples were drawn before and 1, 6, and 20 min after narcotic administration. Of the 16 patients given meperidine (mean dose 4.3 ± 0.2 (SEM) mg/kg), five (31%) had clinical signs (hypotension, tachycardia, erythema) and elevations in plasma histamine levels ranging from 3.2 to 49.7 μg/ml 1 min after narcotic administration. Plasma epinephrine levels at this time were also elevated in these five patients. One of the ten patients given morphine (0.6 ± 0.02 mg/kg) developed hypotension, tachycardia, and an increase in plasma histamine level to 12.4 ng/ml. None of 34 patients given either fentanyl (7 ± 0.4 μg/kg) or sufentanil (1.3 ± 0.1 μg/kg) had clinical signs of histamine release or elevations of plasma histamine levels. In the six patients in whom histamine release occurred, there was a significant correlation between the histamine levels at 1 min and the magnitude of change in heart rate, blood pressure, and plasma epinephrine level. All six histamine releasers were young women, ranging in age from 18 to 35 yr. Histamine release occurred more frequently after meperidine than after the other narcotics, including morphine, and the degree of hemodynamic compromise was related to the increase in plasma histamine concentration.