上腹部手术病人围术期红细胞内己糖激酶、磷酸果糖激酶活性的变化

Perioperative Changes of Erythrocytes HK, PFK Activities in Patients Undergoing Upper Abdominal Surgery

目的 :为了解上腹部手术后红细胞内糖酵解通路是否全面受到抑制 ,观察红细胞内己糖激酶 (HK)和磷酸果糖激酶(PFK)活性的变化。方法 :2 0例择期上腹部手术病人随机分成两组 :硬膜外阻滞 (EB)组 ,异丙酚静脉麻醉 (PRO)组。于麻醉前、手术 6 0 min、术后 6 0 m in、术后第 1天和第 2天 5个时点取静脉血 ,同步测定血糖和 HK、PFK活性。结果 :两组病人术后第 1天 HK和 PFK活性均明显下降。与麻醉前值分别相比较 ,每克 Hb HK活性 :(1.35± 0 .95 )∶ (1.90± 1.0 2 ) IU(P<0 .0 5 ,EB组 ) ;(1.0 1± 0 .42 )∶ (1.91± 0 .6 3) IU(P<0 .0 1,PRO组 )。每克 Hb PFK活性 :(0 .90± 0 .49)∶ (1.86± 0 .49) IU (P<0 .0 1,EB组 ) ;(0 .81± 0 .32 )∶ (1.70± 0 .70 ) IU(P<0 .0 1,PRO组 )。术后 6 0 min和第 1天、第 2天血糖值明显高于麻醉前值 (P<0 .0 5或 P<0 .0 1)。结论 :上腹部术后高血糖状态下 ,红细胞内 HK、PFK活性均下降。提示术后红细胞内糖酵解通路受到全面抑制。

Objective:In order to investigate whether the glycolysis pathway in RBC is totally inhibited. The perioperative changs of erythrocyte hexokinase (HK) and phosphofructokinase (PFK) activities were observed. Methods:Twenty patients under going upper abdominal surgery were randomly divided into epidural blockade group (EB) and intravenous propofol combined anesthesia group (PRO). The venous blood sample were collected for the measurements HK, PFK activities and plasma glucose at five time points: before anesthesia, at 60 min after incision, 60 min after the end of surgery, the 1 st and 2 nd postoperative days.Results:The HK and PFK activities in RBC were decreased significantly on the first postoperative day, which were lower than that before anesthesia in both groups, HK activity: (1.35±0.95)vs(1.90±1.02) IU/g Hb( P<0.05 )in EB and (1.01±0.42)vs(1 91±0 63) IU/g Hb( P<0 01 ) in PRO;PFK activity:(0.90±0.49)vs(1.86±0.49) IU/g Hb( P\%<0.01) in EB and(0.81±0.32)vs(1 70±0.70) IU/g Hb( P<0.01 ) in PRO. The levels of plasma glucose were higher at 60 min after operation and on the 1 st or 2 nd postoperative day than that before anesthesia ( P<0.05 or P<0.01 ). Conclusion:The HK and PFK activities in RBC, as pyruvate kinase (PK) changes in previous our report, were decreased on the first postoperative day under hyperglycemia after upper abdominal surgery, which indicated that glycolysis pathway was inhibited entirely. [