体外循环心脏手术中和手术后红细胞糖代谢限速酶活性的改变  

Perioperative changes of erythrocyte gloucose metabolism in patients undergoing open heart surgery

作　　者：王灿琴[1] 王中云[1] 潘寅兵[1] 钱燕宁[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,南京医学硕士210029

出　　处：《医学研究生学报》2011年第12期1265-1267,共3页Journal of Medical Postgraduates

摘　　要：目的以往研究发现上腹部或胸部手术后第1天存在红细胞内糖酵解途径受抑制,磷酸戊糖途径、多元醇通路相应活跃现象,但不知在体外循环心脏手术患者围麻醉手术期间这些代谢通路是否有改变。文中拟观察体外循环心脏手术中和手术后血糖及红细胞内葡萄糖-6-磷酸脱氢酶(glucose-6-phasphate dehydrogenase,G-6PD)、磷酸果糖激酶(phosphofructokinase,PFK)及醛糖还原酶(aldose reductase,AR)活性的变化。方法对32例体外循环心脏手术患者围麻醉手术期红细G-6PD、PFK及AR活性变化进行了动态观察。分别于麻醉前、锯胸骨、体外心肺转流建立、主动脉阻断5 min、转流结束、手术结束、术后第1天、术后第2天8个时点取动脉血,同步测定血糖及红细胞内G-6PD、PFK、AR活性。结果与麻醉前相比,血糖浓度自主动脉阻断5 min开始,至术后第1天均升高显著(P<0.05);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)。结论体外循环心脏手术中和手术后存在明显的高血糖反应,术后第1天出现红细胞内糖酵解途径受抑制,磷酸戊糖途径、多元醇通路相应活跃现象。Objective We have previously shown that the glycolysis in erythrocytes(RBC) is depressed while pentose phosphorate and polyol pathway was activated in patients undergoing thoracic and upper abdominal surgeries on the 1st postoperative day.But we have not kown how to change of these pathways are involved undergoing open heart surgery.In our present study,we observe the perioperative changes of erythrocyte glucose-6-phasphate dehydrogenase(G-6-PD),phosphofructokinase(PFK),aldose reductase activity in patients undergoing open heart surgery.Methods Thirty-two patients underdoing open heart surgery were admitted to this study.Arterial blood samples were collected for the measurements of blood glucose,G-6PD,PFK,AR activity in RBC at 8 points: before anesthesia induction,spiliting sternum,the begining of CPB,5 minutes after aorta occlusion,at the end of CPB,at the end of operation on the 1st,2nd postoperative day.Results ① The levels of blood glucose were significantly increased at 5 minutes after aorta occlusion compared with the levels before operation and kept on the high levels till the 1st day after operation(P<0.05).② The activity of PFK of RBC was decreased significantly on the 1st postoperative day(P<0.05),G-6-PD and AR activities were increased significantly on the 1st postoperative day(P<0.05).Conclusion There was a significant increased blood glucose in patients undergoing open heart surgery.The glycolysis in RBC was depressed,but the pentose phosphorate and polyol pathway activates were increased on the 1st postoperative day.

关 键 词：血糖 葡萄糖-6-磷酸脱氢酶 磷酸果糖激酶 醛糖还原酶 

分 类 号：R65[医药卫生—外科学]