外循环中β-内啡肽的浓度无影响。 Heydorn等[10]指出应激导致的冠脉痉挛会增加心肌的需氧量,是造成心肌缺 氧的原因之一。应激激素的增多也可能导致心肌的缺氧加剧,这是否与内啡肽的增 多有关尚无定论。经观察发现,正常灌注压、低流量灌注和低压灌注条件下,内啡 肽的增多并无差异,但低压灌注组的心室功能下降最明显,且不能用纳洛酮来改善 心肌功能的状况。 总之,对内啡肽系统在体外循环心脏手术中的生理学和功能还有很多问题需要 进一步阐明,在手术应激反应中内啡肽充当着重要的角色,需要人们更多的认识。 参考文献 1 刘俊杰主编. 现代麻醉学. 北京: 人民卫生出版社, 1987: 27. 2 Carr DB. Surgery anaesthesia and endophine. International Anesthesiol ogy Clinics ,1988, 26: 199. 3李佳春主编.体外循环灌注学.北京:人民军医出版社,1993:166. 4 Hynynen M, Lehtinen AM, Salmenpera M, et al. Effects on plasma cortis ol concentration, beta-endophine immunore activity and arginine vasopre ssin. Br J Anaesth, 1986, 58: 1260. 5 Lacoumenta S, Yeo TH, Paterson JL et al. Hormonal and metabolic respo nses to cardiac surgery with sufentanil-oxygen anaesthesia. Acta Anaest hesiol Scand , 1987, 31: 258. 6 Krieger DT主编 . Neuroendocrinology. USA. 1980: 65. 7 Darbinian TM, Zatevakhina MV, kuznetsova BA, et al. Concentration of beta endorphin in blood as a criterion of adequacy of general anesthesi a. Anesteziol Reanimatol 1993, 2: 9. 8 Cork RC, Hameroff SR, Weiss JL,et al. Effects of halothane and fentan yl anesthesia on plasma beta-endorphin immunoreactivity during cardiac surgery.Anesth Analg, 1985, 64: 677. 9 Howie MB,Hiestand DC,Jopling MW, et al. Effect of oral clonidine prem edication on anesthetic requirement, hormonal response, hemodynamics, a nd recovery in coronary artery bypass graft surgery patients. J Clin An esth, 1996, 8: 263. 10 Heydorn WH, Mres WY, Bellamy RF, et al. Naloxone: in effective in im proving cardiac performance after hypoperfusion in swine. Circ Shock, 1 985, 17: 35.
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