不同镇痛方式对开胸手术患者红细胞醛糖还原酶和血浆葡萄糖及脂质过氧化物的影响  

Effects of different analgesia methods on aldose reductase activity in erythrocytes and the levels of plasma glucose and malonadialdehyde in patients undergoing esophagus surgery

作　　者：张晓坤[1] 潘熊熊[2] 潘寅兵[2] 周芷萱[3] 王灿琴[2] 钱燕宁[2] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,江苏南京210008 [2]南京医科大学第一附属医院麻醉科,江苏南京210029 [3]南京医科大学口腔学院,江苏南京210029

出　　处：《医学研究生学报》2008年第12期1274-1277,共4页Journal of Medical Postgraduates

基　　金：江苏省卫生厅基金资助项目(批准号:H200705)

摘　　要：目的:比较硬膜外和静脉镇痛对开胸手术患者红细胞醛糖还原酶(AR)活性和血浆葡萄糖(Glu)及脂质过氧化物(MDA)浓度的影响。方法:42例在静脉全麻复合硬膜外阻滞麻醉下行开胸食道癌手术患者随机分为Ⅰ、Ⅱ两组,每组21例。术后,Ⅰ组行静脉镇痛(芬太尼15μg/kg),Ⅱ组行硬膜外镇痛(0.125%罗哌卡因混合2μg/ml芬太尼)。在麻醉前(T0)、手术开始60 min(T1)、术后60 min(T2)、术后1 d(T3)和术后2 d(T4)抽取静脉血,测定AR活性及Glu和MDA水平,采用视觉模拟评分(VAS)测定术后4、12、24、48 h镇痛效果。结果:①两组患者术后镇痛效果均良好,但Ⅰ组患者术后12、24 h VAS评分明显高于Ⅱ组(P<0.05),总按压次数明显高于Ⅱ组(P<0.01)。②与T0值相比,T3时Ⅰ组患者红细胞AR活性显著升高(P<0.01),Ⅱ组患者此酶活性无明显上升(P>0.05);此时Ⅰ组患者AR活性明显高于Ⅱ组(P<0.05)。③与T0值相比,两组患者血糖值均从T1时开始升高(P<0.05),至T3时达峰值(P<0.01),T4时点Ⅱ组患者的血糖值下降至术前水平(P>0.05),而Ⅰ组仍未恢复(P<0.05);T3、T4时Ⅰ组血糖值明显高于Ⅱ组(P<0.05)。④Ⅰ组患者血浆MDA值在T3时点明显升高(P<0.01),Ⅱ组患者的MDA值无明显变化(P>0.05),组间比较,有统计学意义(P<0.05)。结论:与静脉镇痛相比较,开胸手术后采用硬膜外镇痛,能降低术后血糖与MDA水平和AR活性,从而减轻红细胞的氧化损伤。Objective： To compare the effect of thoracic epidural analgesia with that of intravenous controlled analgesia on the activity of aldose reductase （AR） in erythrocytes and the concentrations of plasma glucose and malonadialdehyde （MDA） in patients undergoing esophagus surgery. Methods： Forty-two patients scheduled for esophagus surgery under general intravenous anesthesia combined with epidural block were randomly allocated to intravenous patient-controlled analgesia with fentanyl 15μg/kg （group Ⅰ , n = 21 ） and thoracic epidural analgesia with 0. 125% ropivacaine and 2 μg/ml fenta- nyl mixture （ group Ⅱ , n = 21 ） after operation. Venous blood samples were collected for the measure- ment of AR activity in erythrocytes and the levels of plasma glucose and MDA before the induction （ TO ）, 60 min after the initiation of the incision （ T1 ）, and 60 min （ T2 ）, 1 d （ T3 ） and 2 d （ T4 ） after surgery. The effects of analgesia were assessed by visual analog scale （VAS） at 4, 12, 24 and 48 hours postoperatively. Results： Both methods produced satisfactory pain relief, but with significantly higher 12 and 24 h VAS scores and more bolus times in group I （P 〈0.05）. Compared with To, AR activity obviously increased on Tain group I （P 〈0.01 ）, but only slightly changed in group Ⅱ （P 〉0.05）, with significant differences between the two groups （ P 〈 0.05 ）. Plasma glucose was elevated signifi- cantly on T1（P〈0. 01）, reached the peak on T3 （P 〈0. O1 ） and remained high on Tain group I （ P 〈 0.05 ）, but returned to the baseline on T4 （ P 〉 0.05 ） in group Ⅱ, significantly higher on T3 and T4 in the former than in the latter （P 〈 0.05）. The MDA concentration was markedly increased on T3in group Ⅰ （ P 〈 0.01 ）, but only a little in group Ⅱ （ P 〉 0.05 ）. Conclusion ： Compared with intrave- nous analgesia, epidural analgesia effects better pain relief, decreases the levels of Glu and MDA, inhibits AR activi

关 键 词：镇痛 醛糖还原酶 葡萄糖 脂质过氧化物 

分 类 号：R971.2[医药卫生—药品]