围术期红细胞丙酮酸激酶活性的变化  

Perioperative changes of erythrocyte pyruvate kinase activity in patients undergoing abdominal surgery

作　　者：钱燕宁[1,2] 林桂芳[1,2] 屠伟峰[1,2] 尹宁[1,2] 刘存明[1,2] 刘华[1,2] 

机构地区：[1]南京医科大学附属一院麻醉科 [2]南京军区总医院麻醉科

出　　处：《中华麻醉学杂志》1997年第5期269-271,共3页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金

摘　　要：目的：观察围术期红细胞内丙酮酸激酶（ＰＫ）活性的变化。方法：将３０例上腹部手术病人分成硬膜外阻滞（ＥＢ）和静脉普鲁卡因复合麻醉（ＩＰＢＡ）两组。结果：两组病人血糖于手术６０分时均开始明显升高，术后第一天值与基础值比较，ＥＢ组：８．２９±５０，４．８０±０．１８ｍｍｏｌ／Ｌ（Ｐ＜０．０１）；ＩＰＢＡ组：６．３６±０．３３，４．５５±０．１８ｍｍｏｌ／Ｌ（Ｐ＜０．０１）。红细胞内２，３－ＤＰＧ浓度无明显改变。但两组ＰＫ活性于术毕６０分时明显下降。其术后第一天值与基础值分别相比较，ＥＢ组：７．５９±１．０１，１１．６２±１．０６ＩＵ／ｇＨｂ（Ｐ＜０．０５）；ＩＰＢＡ组：７．７５±０．９４，１１．８４±１．１２ＩＵ／ｇＨｂ（Ｐ＜０．０５）。结论：在手术创伤后的高血糖反应下，红细胞内ＰＫ活性明显下降，２，３－ＤＰＧ浓度无变化。这可能与红细胞内糖酵解通路受抑制有关。Objective:To study the perioperative changes of erythrocyte pyruvate kinase(PK)activity.Method:Thirty patients undergoing upper abdominal surgery were divided into epidural blockade(EB)group or intravenous procaine balanced anesthesia(IPBA)group.Result:The blood glucose increased significantly 60 min after incision in both groups.Blood glucose levels on the first postoperative day were significantly higher than the baselines in both groups 8.29±1.5 vs 4.8±0.18mmol/L(P<0.01) in EB,6.36±0.33 vs 4.55±0.18mmol/L(P<0.01)in IPBA .The concentrations of 2,3 DPG in RBC were not significantly changed in both groups.The PK activity in RBC decreased significantly 60 min after operation in both groups.The PK activity levels on the first postoperative day were significantly lower than the baselines in both groups 7.59±1.01 vs 11.62±1.06IU/gHb(P<0.05)in EB;7.75±0.94 vs 11.84±1.12 IU/gHb(P<0.05)in IPBA .Conclusion:The PK activity is decreased and the concentration of 2,3 DPG remaines unchanged under the hyperglycaemic response to surgical injury,which may be related to an inbibition of glycolysis pathway in RBC.

关 键 词：麻醉 红细胞 丙酮酸激酶 高血糖 

分 类 号：R614.24[医药卫生—麻醉学] R656.05[医药卫生—外科学]