不同麻醉和镇痛方式对开胸手术患者红细胞糖代谢限速酶的影响研究

Patients undergoing esophagectomy surgery: effects of different anesthesias and analgesias on their rate-limiting enzyme of sugar metabolism in erythrocytes

目的:探讨心脏开胸手术中采用不同麻醉和镇痛方式对开胸手术患者围手术期磷酸果糖激酶(PFK)、葡萄糖-6磷酸脱氢酶(G-P6D)活性的影响。方法:90例拟行开胸食管癌根治术的患者分为A、B、C三组,A组术中静脉全麻复合硬膜外阻滞,术后行硬膜外罗呱卡因混合芬太尼镇痛;B组术中静脉全麻复合硬膜外阻滞,术后静脉芬太尼镇痛;C组术中静脉全麻,术后静脉芬太尼镇痛。分别于麻醉前(T1)、手术60min(T2)、术后60min(T3)、术后24h(T4)和术后48h(T5)测定红细胞PFK、G-6PD活性。记录术后60min、术后24h和术后48h的VAS评分。结果:三组患者T1时红细胞PFK、G-6PD活性无明显差异(P>0.05),B、C组T4时PFK、G-6PD活性与T1时和A组比较显著降低,相比较有显著性差异(P<0.05);A组患者术后T3、T4时VAS评分显著低于B、C组,相比较有显著性差异(P<0.05),术后T5时三组VAS评分差异无统计学意义(P>0.05)。结论:对开胸手术患者术中采用全麻复合硬膜外阻滞、术后采用硬膜外镇痛,可减少氧化应激损伤和对机体内平衡的影响。

Objective： To evaluate the different anesthesias and analgesias on the effects of glycometabolism rate-limiting enzymes in erythrocytes in patients undergoing esophagectomy surgery. Methods： 90 patients undergoing esophagectomy surgery were divided into A, B and C group. The A and B group both receiving general anesthesia combined with thoracic epidural anesthesia and either intravenous patient controlled analgesia with thoracic epidural analgesia with ropicaine and fentany （group A） or fentanyl （group B ） after operation, the group C receiving only genaral anesthesia followed by intravenous patient controlled analgesia with fentanyl. The PFK and G-6PD activities in erythrocytes were detected before induction （T1）, at 60min following the incision（T2）,60min（T3）after operation, 24h （T4）after operation and 48h （T5）after operation. The VAS score was recorded 60min （T3）, 24h （T4） and 48h （T5）after operation. Results： Compared with these at T1,the PFK and G-6PD activities in erythrocytes of the three groups was not significantly different （P〉 0.05）. Compared with these at T1 and A group, the PFK and G-6PD activities in erythrocytes of the B and C group at T4 were significantly lower, compared the difference was significant （P 〈0.05）; The VAS score of A group at T3 and T4 were significantly lower than the B and C group, compared the difference was significant （P 〈0.05）, the VAS score of three groups at T5 was not significantly different （P〉 0.05）. Conclusion： The general anesthesia combined with epidural anesthesia and analgesia can reduce the oxidative stress injury and Influence on internal balance of the body in patients undergoing esophagectomy surgery.