爱维治对食管手术患者血糖、血浆胰岛素、乳酸与红细胞磷酸果糖激酶活性的影响

Effects of actovegin on blood glucose,plasma insulin,plasma lactic acid and erythrocytes PFK activity in patients undergoing esophagus surgery

目的:观察麻醉前使用爱维治对食管手术患者血糖、血浆胰岛素、乳酸与红细胞糖酵解限速酶磷酸果糖激酶(PFK)活性的影响。方法:择期40例食管癌手术患者随机分为2组:对照组采用异氟醚吸入全麻,维持异氟醚呼气末浓度1.2MAC;爱维治组麻醉方法同对照组,但麻醉前30min予爱维治20mg/kg静滴。分别于麻醉前(T1)、手术90min(T2)、术后60mi(nT3)、术后第1天晨(T4)和术后第2天晨(T5)抽取外周静脉血,测定血糖、胰岛素、血乳酸及红细胞内PFK活性,计算胰岛素敏感性指数(ISI)。结果:①两组血糖值与麻醉前值相比均升高(P<0.05),T3时爱维治组血糖值低于对照组(P=0.034);②T4时爱维治组血浆胰岛素浓度与麻醉前值比较无显著上升(P=0.732),但对照组血浆胰岛素浓度明显升高(P=0.003),两组之间比较差异有显著性(P=0.035);③两组ISI在T4时与麻醉前值相比均降低(P<0.05),但爱维治组明显高于对照组(P=0.045);④T4时爱维治组红细胞PFK活性与麻醉前值比较无明显降低(P=0.055),但对照组红细胞PFK活性明显降低(P=0.001),两组之间比较差异有显著性(P=0.044);⑤T3时爱维治组血乳酸浓度未明显上升(P=0.114),但对照组血乳酸浓度较麻醉前值明显升高(P=0.000),两组之间比较差异有显著性(P=0.036)。结论:爱维治能减轻食道癌手术患者手术应激引起的胰岛素抵抗和高血糖反应,增强红细胞磷酸果糖激酶的活性,抑制乳酸生成。

Objective：In order to investigate the effects of actovegin administrated before anesthesia on blood gluense（BG）, plasma insulin（INS）, plasma lactic acid（LA） and erythrocytes glycolysis rate-limiting enzyme, phosphofructokinase（PFK） activities in patients undergoing esophagus surgery. Methods：Forty patients scheduled for esophagus surgery were randomly divided into two groups： control group and actovegin group. Isoflurane inhalation anesthesia was used in both groups and isoflurane was administrated at 1.2 MAC end-tidal concentration, Actovegin （20 mg/kg） was administrated intravenously before anesthesia in actovegin group. Blood samples were taken from peripheral vein for determination of BG, plasma INS, plasma LA and erythrocytes PFK activities. Insulin sensitivity index（ISI） was calculated. Samples were ohtained hefore anesthesia（T1 ）, 90 rain after the start of surgery（T2）, 60 min after the end of surgery（T3）, first postoperative morning（T4） and second postoperative morning（T5）. Results：In both groups, BG was increased significantly（P 〈 0.05） compared with those before anesthesia. On T3, BG was significantly lower（P= 0.034） in actovegin group than that in control group. On T4, there was no significant difference（P = 0.732） in INS in actovcgin group but significant difference（P = 0.003） in control group compared with those before anesthesia, and there was significant difference in INS between two groups （P = 0.035）. On T4 ISI was reduced signifcantly （P 〈 0.05） compared with those before anesthesia in both groups, but ISI was significantly higher（P = 0.045） in actovegin group than that in control group. On T4, there was no significant difference（P = 0.055 ） in PFK in actovegin group but significant difference （P = 0.001 ） in control group compared with those before anesthesia,and there was significant difference between two groups （P = 0.044）. On T3, there was no significant difference （P = 0.114） in LA in actovegin group but significant difference（P = 0.000） in control group compared with those before anesthesia, and there was significant difference between two groups （P = 0.036）. Conclusion：Actovegin could decrease insulin resistance and the increased reaction of blood glucose originated stress, enhance PFK activity of erythrocytes and inhibit the production of lactic acid in patients undergoing esophagus surgery activity.