不同麻醉方法对28例胃癌手术患者红细胞醛糖还原酶及血浆一氧化氮的影响  

The Effects of Different Anesthesiaes on the Activity of Aldose Reductase in RBC and the Level of Plasma Nitric Oxide in Patients undergoing Gastric Cancer Operation

作　　者：解成兰[1] 钱燕宁[1] 王灿琴[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2004年第2期168-170,共3页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省自然科学基金资助项目(BJ97003)

摘　　要：目的:观察不同麻醉方法对胃癌手术患者红细胞醛糖还原酶(AR)活性及血浆一氧化氮(NO)浓度的影响。方法:28例胃癌手术患者随机分为两组,组1吸入1.5～2.0最小肺泡吸入有效浓度(MAC)的异氟醚,组2为0.5～1.0MAC异氟醚复合硬膜外麻醉。分别于麻醉前30min、手术90min、术后60min、术后1天和术后2天5个时间点抽取静脉血,测定血糖浓度、红细胞AR活性及血浆NO浓度。结果:与麻醉前值相比,组1病人血糖浓度于手术90min、术后60min、术后1天明显升高(P<0.05或P<0.01);术后1天红细胞AR活性明显升高(P<0.05),同时血浆NO浓度显著下降(P<0.05)。组2病人血糖浓度于手术90min、术后60min显著升高(P<0.01);红细胞AR活性及血浆NO浓度,虽有与组1病人相似的变化趋势,但与麻醉前值相比,各时间点无明显变化。术后1天组1病人红细胞AR活性明显高于组2(P<0.05),而血浆NO浓度则相反(P<0.05),两组间血糖无明显差异。结论:胃癌手术病人在应激高血糖状态下,红细胞多元醇途径被激活的同时血浆NO合成受抑制。全麻联合硬膜外阻滞能较好抑制这一改变。Objective: To investigate the effects of different anesthesiaes o n the activity of aldose reductase(AR)in RBC and the level of plasma nitric oxid e(NO)in patients undergoing gastric cancer operation. Methods: Twenty-eight p atients undergoing gastric cancer operation were randomly half divided into two groups. Anesthesia was maintained with 1.5～2.0 MAC isoflurane inhalation in gro up Ⅰ, with 0.5～1.0 MAC isoflurane plus epidural block in group Ⅱ. Venous bloo d samples were collected to measure AR activity, plasma NO and blood glucose. Re sults: The levels of blood glucose were significantly increased at 90min after i ncision compared with the levels before operation and kept on the high levels ti ll the 1st day after operation in groupⅠ(P< 0.05 or P< 0.01), the changes in group Ⅱwere same as in group Ⅰ(P< 0.01). There was no significant difference between two groups. The activity of AR in RBC was increased significantly and t he level of plasma NO was decreased significantly on the 1st day after operation in group Ⅰ(P< 0.05). In group ⅡAR and NO slightly altered, but these altera tions were not significant. The extent of changes in the activity of AR and the level of NO on the 1st day after operation in group Ⅱwas less than that in grou p Ⅰ(P< 0.05). Conclusion: The polyol pathway in RBC is activated in surgical hyperglycemia while the production of NO is inhibited in patients undergoing gas tric cancer operation, which can be attenuated by the combined general-epidural anesthesia. [

关 键 词：异氟醚 硬膜外麻醉 醛糖还原酶 一氧化氮 血糖 

分 类 号：R614[医药卫生—麻醉学] Q554.9[医药卫生—外科学]