地氟醚吸入麻醉下开胸手术对红细胞糖代谢和膜脂流动性的影响

The Effects of Thoracic Surgery and Desflurane Anesthesia on Human Glucose Metabolism and Lipid Fluidity of Erythrocyte

目的 :观察地氟醚吸入麻醉下开胸手术对人红细胞糖代谢和膜脂流动性的影响 ,探讨吸入麻醉对应激反应的调节和控制。方法 :择期开胸手术患者 2 0例 ,依据吸入地氟醚肺泡浓度随机分为 1.0肺泡最低有效浓度 (minimal alveolar concentration,MAC)和 1.5 MAC组。观察 2组患者围术期红细胞磷酸果糖激酶 (PFK)、葡萄糖 - 6磷酸脱氢酶 (G- 6 PD)及膜脂流动性的变化。结果 :两组患者红细胞 PFK活性于术后第 1天下降显著 ,同时 G- 6 PD活性显著上升。两组红细胞膜荧光偏振度术中及术后无明显改变 ,即膜脂流动性无明显变化。结论 :1大手术后红细胞 PFK活性上升 ,G- 6 PD活性下降 ,这种改变是机体对手术作出的应激反应 ,可能与红细胞加强抗氧化能力有关。2红细胞膜脂流动性无明显改变 ,可能与其糖代谢通路的重新平衡有关。

Objective:To investigate the effects of thoracic su rg ery and desflurane anesthesia on human glucose metabolism and lipid fluidity of erythrocyte (RBC). Methods:20 ASA Ⅰ-Ⅱ patients, undergoing electi ve thoracic surgery, were randomly allocated to 1.0 MAC or 1.5 MAC group accordi ng to desflurane alveolar concentration. Phosphofructokinase (PFK) and glucose- 6 phosphate dehydrogenase (G-6PD) activities and RBC lipid fluidity were observ ed perioperatively. Results:The activities of PFK decreased significan tly on the 1 st postoperative day and G-6PD activities increased significantly at the same time in both groups. There was no any significant difference in the degree of fluorescence polarization of RBC membrane in both groups. Concl usion:①The changes of enzyme activities of glucose metabolism in RBC after major surgery are the responses to surgery-induced stress. which may be related to enhanced antioxidation of RBC. ②The unchanged RBC lipid fluidity may be rel ated to the rebalance of two glucose metabolism pathways in RBC. ③Sufficient in halation anesthesia depth can attenuate surgical stress response to some extent.