EFFECT OF A SINGLE BOLUS OF ETOMIDATE UPON EIGHT MAJOR CORTICOSTEROID HORMONES AND PLASMA ACTH
EFFECT OF A SINGLE BOLUS OF ETOMIDATE UPON EIGHT MAJOR CORTICOSTEROID HORMONES AND PLASMA ACTH
复制标题
单次推注依托咪酯对八种主要皮质类固醇激素和血浆 ACTH 的影响
作者：
B. Allolio;H. Dörr;R. Stuttmann;D. Knorr;D. Engelhardt;W. Winkelmann
在一项前瞻性对照试验中，我们研究了诱导剂量依托咪酯（0.26 mg/kg静脉注射）对7名接受全身麻醉的男性血浆ACTH、黄体酮、17α - oh -黄体酮、11 -脱氧皮质醇、皮质醇、可的松、皮质酮、11 -脱氧皮质酮和醛固酮的影响。另外7名男性患者在诱导时接受硫喷妥（5.0 mg/kg静脉注射）作为对照。依托咪酯组血浆ACTH浓度升高（346±124 vs 117±74 pg/ml，平均值±SEM），但差异无统计学意义。与硫喷妥诱导后血浆皮质醇（P<0.01）、可的松（P<0.01）、皮质酮（P<0.01）和醛固酮（P<0.05）水平相比，应用依咪酯后血浆皮质醇（P<0.01）、皮质酮（P<0.01）和醛固酮（P<0.05）水平明显降低。使用依托咪酯后210分钟，血浆11 -脱氧皮质醇和11 -脱氧皮质酮浓度显著升高（分别为91±28 nmol/1和7.04±0.47 nmol/1， P<0.01），表明糖皮质激素和矿化皮质激素中间体的11 - β -羟基化受到抑制。相比之下，血浆孕酮和17α - OH -孕酮水平在两组之间没有显著差异，这表明胆固醇侧链裂解酶对依托咪酯的敏感性低于11β -羟化酶。我们的研究结果表明，在单剂量依托咪酯诱导麻醉后，抑制皮质类固醇-合成途径中的其他酶（如胆固醇-侧链裂解酶）的临床相关性很小。
In a prospective controlled trial we investigated the effect of an induction dose of etomidate (0.26 mg/kg i.v.) on plasma ACTH, progesterone, 17αOH‐progesterone, 11‐deoxycortisol, cortisol, cortisone, corticosterone, 11‐deoxycorticosterone, and aldosterone in seven males undergoing general anaesthesia. Seven other male patients receiving thiopentone at induction (5.0 mg/kg i.v.) served as controls. Plasma ACTH concentrations rose higher in the etomidate group (346 ± 124 vs. 117 ± 74 pg/ml, mean ± SEM), but the difference was not significant. After etomidate we found a clear suppression of plasma cortisol (P<0.01), cortisone (P<0.01), corticosterone (P<0.01), and aldosterone (P<0.05) compared to corticosteroid levels after induction with thiopentone. Plasma 11‐deoxycortisol and 11‐deoxycorticosterone concentrations were grossly elevated 210 min after etomidate (91 ± 28 nmol/1 and 7.04 ± 0.47 nmol/1, respectively, P<0.01) demonstrating inhibition of 11β‐hydroxylation of both glucocorticoid and mineralocorticoid intermediates. In contrast, no significant difference in plasma progesterone and 17α‐OH‐progesterone levels was found between the two groups indicating that the cholesterol‐side‐chain cleavage enzyme is less sensitive to etomidate than 11β‐hydroxylase. Our results suggest that after induction of anaesthesia with a single bolus of etomidate, inhibition of other enzymes in the corticosteroid‐synthetic pathway (e.g. cholesterol‐side‐ chain cleavage enzyme) is of little clinical relevance.
影响因子：
158.5
作者：
WAGNER, RL;WHITE, PF;FELDMAN, D
通讯作者：
FELDMAN, D