右美托咪定对胃癌手术老年患者红细胞糖代谢限速酶和血糖及丙二醛浓度的影响

目的观察右美托咪定对胃癌手术老年患者红细胞糖代谢限速酶活性和血糖及丙二醛(MDA)浓度的影响。方法选择胃癌手术老年患者60例,男38例,女22例,年龄60~80岁,ASAⅠ或Ⅱ级,随机分为两组,每组30例。右美托咪定组(D组)术前10 min静脉泵注右美托咪定0.5μg/kg,术中右美托咪定静脉维持0.3μg·kg~(-1)·h-1,对照组(C组)术前、术中静脉泵注等量的生理盐水。分别于麻醉前(T_0)、手术60min(T_1)、术后60 min(T_2)、术后1d晨(T_3)和术后2d晨(T_4)抽取肘静脉血,测定红细胞磷酸果糖激酶(PFK)、葡萄糖-6-磷酸脱氢酶(G-6PD)和醛糖还原酶(AR)的活性及血糖和血浆丙二醛(MDA)的浓度。结果与T_0时比较,T_3时两组PFK活性明显降低(P0.05),G-6PD和AR活性明显升高(P0.05或P0.01),且D组PFK活性明显高于、G-6PD和AR活性明显低于C组(P0.05)。T_1时两组血糖浓度开始升高(P0.01),至T_3时达峰值(P0.01);T_1~T_3时D组血糖浓度均明显低于C组(P0.05)。与T_0时比较,T_3时两组血浆MDA浓度在T_3时明显升高(P0.01),D组MDA浓度明显低于C组(P0.05)。结论右美托咪定可降低胃癌手术老年患者围术期血糖浓度,减轻氧化应激,改善红细胞糖代谢状态。

Effects of dexmedetomidine on the glycometabolism rate-limiting enzymes in erythrocytes and the plasma levels of glucose and malondialdehyde in patients undergoing radicalgastrectomy for cancer

Objective To investigate the effects of dexmedetomidine on the activities of glycome-tabolism rate-limiting enzymes in erythrocytes and the plasma levels of glucose and malondialdehyde in pa-tients undergoing radical gastrectomy for cancer.Methods Sixty patients,38 males and 22 females,aged 60-80 years,scheduled for radical gastrectomy for cancer were randomly divided into dexmedetomidine group (group D)and control group (group C),30 cases in each group.The patients in group D were intra-venously infused 0.5 μg/kg dexmedetomidine 10 minutes before operation and perioperatively followed by an infusion at a rate of 0.3 μg·kg-1 ·h-1 until the abdomen were closed.Group C was infused the same a-mount of normal saline.Venous blood samples were collected for the measurement of phosphofructokinase (PFK),glucose-6-phasphate dehydrogenase (G-6PD)and aldose reductase (AR)activities in erythrocytes and the plasma levels of glucose and malondialdehyde (MDA)before induction (T0 ),60 min following the incision (T1 ),60 min (T2 ),day 1 (T3 )and day 2 (T4 )after operation.Results Compared with these at T0 ,the activity of PFK was decreased significantly and the activities of G-6PD and AR were increased markedly at T3 in both groups (P <0.05 or P <0.01),however the activity of the PFK was significantly higher,G-6PD and AR were significantly lower in group D than those in group C (P <0.05).The levels of plasma glucose elevated significantly at T1 (P <0.01),reached high peak values at T3 (P <0.01)and fell at T4 in both groups.The values of plasma glucose in group D were lower than those in group C at T1 ,T2 and T3 (P <0.01).The MDA concentration in both groups increased significantly at T3 (P <0.01),while that of group D was lower than group C (P < 0.05 ).Conclusion Dexmedetomidine could markedly decrease glucose level and alleviate oxidative stress and improve these erythrocyte glucose metabolism changes after radical gastrectomy for cancer in old patients.