不同麻醉方法对腹腔手术患者应激红细胞糖代谢的影响  

Effects of different anesthetic techniques on stress-induced disterbance of glucose metabolism in RBC in patients undergoing abdominal surgery

作　　者：解成兰[1] 潘寅兵[2] 王灿琴[2] 王忠云[2] 钱燕宁[2] 

机构地区：[1]淮安市第二人民医院麻醉科,江苏省223002 [2]南京医科大学第一附属医院麻醉科

出　　处：《江苏医药》2012年第4期458-460,共3页Jiangsu Medical Journal

基　　金：江苏省重点学科外科学课题(10312100210);淮安市卫生局资助课题(hw200504)

摘　　要：目的研究麻醉对红细胞糖代谢的影响。方法 40例择期腹腔手术患者随机均分成两组。A组采用异氟烷吸入全身麻醉;B组采用异氟烷吸入联合连续硬膜外麻醉。分别于麻醉前30min(T0)、手术90min(T1)、术后60min(T2)及术后第1天(T3)、2天(T4)测定血糖(BG)、丙二醛(MDA)、谷胱甘肽(GSH)浓度及磷酸果糖激酶(PFK)、红细胞6-磷酸葡萄糖脱氢酶(G-6PD)和醛糖还原酶(AR)活性。结果与T0比较,T1-T3两组BG均显著升高(P<0.01);T3时A组BG显著高于B组(P<0.05)。与T0比较,A组T3时,MDA与GSH浓度显著升高(P<0.05),PFK活性显著下降(P<0.05),G-6PD和AR活性显著升高(P<0.05或P<0.01);而B组的变化趋势虽与A组相似,但与T0比较均无统计学差异(P>0.05)。结论与单纯异氟烷全麻比较,异氟烷复合硬膜外麻醉可减轻手术创伤对红细胞糖代谢的影响。Objective To study the effects of different anesthetic techniques on stressinduced disterbanee of glucose metabolism in RBC in patients undergoing abdominal surgery. Methods Fourty patients undergoing selective abdominal surgery were equally randomized into two groups of A （anesthetized with isoflurane inhalation alone） and B（anesthetized with isoflurane inhalation plus epidural block）. The venous samples were collected at 30 rain before anesthesia （TO）, 90 min（T1） during operation, 60 min （ T2 ）, on the 1st day （T2） and 2nd day （T3） after surgery for the measurements of PFK, G-6PD, AR activities and the levels of plasma BG, MDA and GSH. Results Compared to TO, BG at T1 to T3 was significantly elevated in both groups（P〈0. 01）, which at T3 was higher in group A than that in group B（P〈0. 05）. Compared to T0,MDA and GSH were higher （P〈0. 05）, the activity of PFK was lower（P〈0. 05）, and the activities of G-6PD and AR were higher （P〈0.05 or P〈0. 01） in group A at T3. Compared to TO, the changes in PFK, G-6PD, AR activities and BG were not significant in group B at T3 （P〈0. 05）. Conclusion Compared to anesthesia with isoflurane inhalation alone, lsoflurane inhalation combined with epidural block can attenuate the impact of surgical stress on glucose metabolism in RBC.

关 键 词：异氟烷 硬膜外阻滞 红细胞糖代谢 

分 类 号：R614[医药卫生—麻醉学]