摘要
目的 探讨开胸手术患者红细胞内糖代谢限速酶活性的变化及不同麻醉方法对其的影响。方法 48例ASAI～Ⅱ级择期开胸手术患者,按麻醉方式随机分成三组,每组16例。Ⅰ组采用地氟醚吸入为主的全身麻醉;Ⅱ组采用异氟醚吸入为主的全身麻醉;Ⅲ组采用异氟醚吸入联合连续硬膜外阻滞。于麻醉前、手术90min、术后60min及术后第1、2天共五个时点分别测定血糖浓度及红细胞6-磷酸葡萄糖脱氢酶(G-6PD)、磷酸果糖激酶(PFK)和醛糖还原酶(AR)活性。结果 与麻醉前比较,三组患者血糖浓度自术中90min开始,至术后第2天升高显著(P<0.05);Ⅰ、Ⅱ两组术后第1天PFK活性显著下降(P<0.05),G-6PD、AR活性显著升高(P<0.05),而Ⅲ组各时点红细胞内糖代谢限速酶活性的变化与麻醉前比较均无统计学差异(P>0.05),且Ⅲ组术后第1天PFK值远低于Ⅰ组相应值。结论 开胸手术中、手术后存在明显的高血糖反应。术后第1天,红细胞内会出现糖酵解途径受抑制,磷酸戊糖途径、多元醇通路相应活跃现象。采用异氟醚吸入联合硬膜外阻滞可在一定程度上调控手术创伤对红细胞糖代谢的影响。
Objective To study the change and effect of different anesthetic methods on the activities of rate-limited enzymes of erythrocyte gloucose metabolism in patients undergoing thoracic surgery. Methods 48 ASA physical status Ⅰ-Ⅱ patients, scheduled for elective thoracic surgery were randomly allocated to three groups with 16 cases each. The anesthesia was maintained mainly with desflurane inhalation in group Ⅰ,isoflurane inhalation in group Ⅱ,or isoflurane inhalation combined with epidural block in group Ⅲ. The venous samples were collected for the measurements of PFK,G-6PD,AR activities and the levels of plasma glucose at 90 min after incision, 60 min after surgery and on the 1st,2nd postoperative days. Results (1) The levels of plasma glucose were increased significantly at 90 min after incision and kept at a high level till the 2nd postoperative day in all three groups (P<0.05) compared with those before anesthesia. (2) The erythrocyte activity of PFK decreased significantly on the 1st postoperative day in group Ⅰ and Ⅱ (P<0.05),G-6PD and AR activities increased significantly on the 1st postoperative day in group Ⅰ and Ⅱ (P<0.05),but all not in group Ⅲ. The change of PFK in group Ⅲ was less than that in group Ⅰ (P<0.05). Conclusion There is a significant increase of blood glucose in patients undergoing thoracic surgery. The glycolysis in RBC is depressed, but the pentose phosphorate and polyol pathway activates increased on the 1st postoperarive day. Isoflurane inhalation combined with epidural block can effectively attenuate the changes of glucose metabolism in erythrocyte.
出处
《临床麻醉学杂志》
CAS
CSCD
2004年第4期195-197,共3页
Journal of Clinical Anesthesiology
基金
江苏省科技厅项目(BJ97003)
江苏省医学重点人才项目(RC2002058)资助
