Comparison Of Surgical Stress By Urine Catecholamines

腎機能障害のない予定手術患者149名を対象とした.NLAとGOE群に分け,回復室での尿中ノルエピネフリン(NE)とエピネフリン(Epi)を測定し,手術侵襲の大小について検討した.NLA下の尿NE, Epi濃度は対照値に比較してそれぞれ肝切除後8.6倍,20.8倍,大腸9.5倍,17.5倍,胃5.9倍,15.1倍,肺4.7倍,12.7倍,THRなどの整形外科手術4.5倍,10.0倍,胆嚢4.5倍,8.0倍,子宮2.4倍,7.3倍,甲状腺手術1.7倍,5.9倍の順に有意に増加した.一方,GOE下ではNE濃度の増加は著明ではなかった.回復室での鎮痛薬使用はNLAが5%に対してGOEは59%であった.以上より,(1)回復室での尿CA濃度から手術侵襲程度が比較できた.(2) NLAでは痛み刺激に無関係に副腎-交感神経系の活性亢進が示唆された.(3) GOEでは疼痛を訴えること,EpiがNEより高値を示したことから末梢神経線維の麻酔からの回復過程に差があると考えられる.

[1]  T. Nishino,et al.  Responses of Recurrent Laryngeal, Hypoglossal, and Phrenic Nerves to Increasing Depths of Anesthesia with Halothane or Enflurane in Vagotomized Cats , 1985, Anesthesiology.

[2]  G. Smith,et al.  Sympathoadrenal responses to anaesthesia and surgery. , 1984, British journal of anaesthesia.

[3]  B. Hamberger,et al.  Plasma Catecholamines During Surgical Stress: Differences Between Neurolept and Enflurane Anaesthesia , 1983, Acta anaesthesiologica Scandinavica.

[4]  J. Kalbfleisch,et al.  Halothane and the Carotid Sinus Reflex: Evidence for Multiple Sites of Action , 1982, Anesthesiology.

[5]  E. Spitznagel,et al.  Plasma Epinephrine and Norepinephrine Levels during Anesthesia: Enflurane‐N2O‐O2 Compared with Fentanyl‐N2O‐O2 , 1982, Anesthesia and analgesia.

[6]  J. Moss,et al.  Renal Function and Stress Response during Halothane or Fentanyl Anesthesia , 1981, Anesthesia and analgesia.

[7]  T. Stanley,et al.  Plasma Catecholamine and Cortisol Responses to Fentanyl–Oxygen Anesthesia for Coronary-artery Operations , 1980 .

[8]  J. Halter,et al.  Mechanism of plasma catecholamine increases during surgical stress in man. , 1977, The Journal of clinical endocrinology and metabolism.

[9]  J. Vane,et al.  Disappearance of Catecholamines from the Circulation , 1968, Nature.

[10]  J. Vane,et al.  Half-lives of Peptides and Amines in the Circulation , 1967, Nature.

[11]  U. V. von Euler,et al.  The effect of stimulation of autonomic areas in the cerebral cortex upon the adrenaline and noradrenaline secretion from the adrenal gland in the cat. , 1958, Acta physiologica Scandinavica.