不同麻醉方法对胸科手术病人红细胞内糖代谢及血浆脂质过氧化物、谷胱甘肽的影响

目的:观察不同麻醉方法对开胸手术病人红细胞葡萄糖-6磷酸脱氢酶(G-6PD)、磷酸果糖激酶(PFK)活性、血浆脂质过氧化物(MDA)及谷胱甘肽(GSH)的影响。方法:28例胸科手术病人随机分为A、B两组,A组单纯吸入1.5～2.0最低肺泡吸入有效浓度(MAC)的异氟醚全麻,B组为1.0 MAC异氟醚复合连续硬膜外麻醉。于麻醉前、手术60 min、术后1 h、术后第1天和术后第2天分别取静脉血,测定红细胞G-6PD、PFK活性及血浆MDA、GSH浓度。结果:与麻醉前值相比A组病人术后第1天红细胞G-6PD活性明显上升,PFK活性显著下降(P<0.05);同时血浆MDA浓度显著上升,GSH浓度显著下降(P<0.05)。B组上述指标变化程度均显著低于A组(P<0.05)。结论:开胸手术后红细胞糖代谢向抗氧化应激方向重新调定,异氟醚全麻复合硬膜外阻滞可减缓此变化。

The Effect of Different Anesthesiaes on the Changes of G-6PD,PFK,MDA and GSH in Patients Undergoing Thoracic Operation

Objective: To investigate the effect of different anesthesiaes on the activities of phosphofructokinase(PFK), glu-cose-6-phasphate dehydrogenase (G-6PD)in RBC and the levels of plasma malonadialdehyde (MDA) and glutathione (GSH) in the patients undergoing thoracic operation. Methods: Twenty-eight patients undergoing thoracic operation were randomly allocated to two groups with 14 cases for each. Anesthesia was maintained with 1. 5-2. 0 MAC isoflurane inhalation in group A, 1. 0 MAC isoflurane plus epidural block in group B. Venous blood samples were collected for the measurement of PFK, G-6PD activities and of plasma MDA, GSH. Results: The plasma MDA and the activities of G-6PD in RBC were increased significantly and the plasma GSH and the activities of PFK in RBC were decreased significantly on the 1st postoperative day in group A( P < 0. 05) as compared with the levels before operation. The degree of changes in all items in group B was less than that in group A. Conclusion: The change in glucose metabolism of RBC has a tendency to develop the antioxidative stress responses. This change is moderate in the patients undergoing thoracic operation with isoflurane combined epidural anesthesia.