心脏外科手术中全身麻醉和体外循环对血浆内源性大麻素浓度的影响

The effect of general anaesthesia and cardiopulmonary bypass on concentrations of plasma endocannabinoid during cardiac procedure

目的探讨心脏外科手术中异氟烷/舒芬太尼全身麻醉及体外循环(CPB)对血浆内源性大麻素花生四烯酸乙醇胺(ANA)浓度的影响。方法选取2011年1月～2011年12月间于我院在全身麻醉及CPB下行心脏外科手术治疗的14例住院患者为研究对象进行前瞻性研究。采用咪唑安定及舒芬太尼麻醉诱导,异氟烷及舒芬太尼麻醉维持。在以下5个时间段抽取患者血样:全身麻醉诱导前及诱导后、心脏外科手术开胸时、CPB过程中及结束后。采用高效液相色谱法-串联质谱法测量血浆ANA浓度。结果①在麻醉诱导后血浆ANA浓度明显降低,由清醒状态(0.36±0.13)ng/ml降至无意识状态(0.25±0.10)ng/ml(P<0.01);在外科手术和CPB期间,ANA浓度始终明显低于麻醉诱导前水平(P<0.01)。②血浆ANA浓度在麻醉诱导前与患者体表面积呈正相关(r=0.45,P=0.03);ANA浓度与CPB期间去甲肾上腺素最大使用剂量呈正相关(r=0.48,P=0.03);ANA浓度与CPB结束后胰岛素最大使用量呈负相关(r=-0.14,P=0.04)。结论全身麻醉后血浆ANA浓度明显减小,其原因可能与意识丧失后应激反应减小有关。血浆ANA浓度变化与一些临床参数有关。

Objective Changes of plasma endocannabinoid arachidonyl ethanolamide （ANA） during cardiac surgery under general anaesthesia with isoflurane/sufentanil, and during cardiopulmonary bypass （CPB） were studied. Methods Fourteen patients undergoing cardiac surgery with CPB were studied. Midazolam and sufentanil were used for induction, and isoflurane and sufentanil for maintenance of general anaesthesia. Blood samples were drawn before and after induction of general anaesthesia, during surgery （ sternotomy）, during and post CPB. Endoeannabinoid measurements were performed by HPLC - tandem mass spectrometry. Results 1. There was a significant decline in plasma ANA concentrations after induction of general anaesthesia （ （0.36 ± 0. 13 ） vs （0.25 ± 0. 1 0） ng/ml, P 〈0. 01 ）, and it remained low level during CPB period （ all P 〈 0.01 ）. 2. Preoperative ANA concentrations correlated positively with the body surface area of the patients （r = 0.45, P = 0.03）. ANA concentrations during CPB correlated positively with the maximum intraoperative dose of norepinephrine （ r = 0.48, P = 0.03 ）, whereas ANA concentrations after CPB correlated negatively with the maximum dose of insulin （r = - 0.14, P = 0.04 ）. Conclusion General anaesthesia with isoflurane reduces plasma ANA concentrations significantly. This may be a consequence of stress reduction after loss of consciousness. Changes in ANA concentrations are related to a number of clinical parameters.