Comparisons of different methods of anesthesia and analgesia on the levels of glycometabolism rate-limiting enzymes in erythrocytes and plasma glucose and stress hormones in patients undergoing esophagus surgery

摘要

Objective: To compare the effects of different methods of anesthesia and analgesia on the activities of phosphofmctokinase(PFK), glucose-6-phosphate dehydrogenase(G-tPD) and aldose reductase(AR) in erythrocytes and levels of plasma glucose and stress hormones in patients undergoing esophagus surgery. Methods: Sixty-two patients scheduled for esophagus surgery were randomly divided into three groups: group I (n = 20) receiving only general anesthesia(GA) followed by intravenous patient controlled analgesia(PCA) with fentanyl 15 μg/kg. The other two groups receiving both general anesthesia combined with thoracic epidural anesthesia (GEA) and either intravenous PCA with fentanyl 15 μg/kg (group Ⅱ, n = 21) or thoracic epidurai analgesia(TEA) with 0.125% ropivaeaine and 0.0002% fentanyl mixture(group Ⅲ, n = 21) after the operation. Venous blood samples were collected for measurements of PFK, G-tPD and AR activities in erythrocytes and plasma glucose, conisol, epinephrine and norepinephrine before induction (T,1), 60 rain following the incision (T,2), 60 min(T,3) after operation, on the lst(T,4) and 2nd postoperative day(T5). Results: The activities of PFK decreased(P＜0.01 or P=0.004) and the activities of G-tPD and AR increased(P＜0.01) in groups Ⅰ and Ⅱ on T,4 compared with those on T,1. Between the two groups, the activities of these enzymes in group Ⅱ changed less than those of group Ⅰ (P＜0.01 or P＜0.05). These enzymes activities changed slightly in group Ⅲ on T,4(P＞0.05). There were significant differences between group Ⅲ and the other two groups(P＜0.01 or P＜0.05). The levels of plasma glucose increased significantly on T,2(P＜0.01), reached peak values on T,4(P＜0.01) and fell on T,5 in the three groups. Compared to those of groups Ⅰ and Ⅱ, the values of plasma glucose in group Ⅲ were lower on T,4 and T,5(P＜0.05 or P＜0.01). The cortisol concentration in each group increased significantly at T,2(P＜0.01 or P＜0.05), and remained elevated on T,5(P＜0.01 or P＜0.05), while on T,2 and T,3 the cortisol levels of group Ⅰ were higher than that of groups Ⅱ and Ⅲ (P＜0.05). The levels of group Ⅲ were lower than those of the other groups on T,4 and Ts(P＜0.01 or P＜0.05). The levels of epinephrine and norepinephrine were also significantly higher in group Ⅰ than those of the other two groups on T,2(P＜0.01 or P＜0.05), and their levels in group Ⅰ and Ⅱ were higher than that of group Ⅲ on T,4. The patients of the three groups obtained satisfactory pain relief, with all Vidual Analogue Scale(VAS) scores less than 3. VAS scores of group Ⅰ were much greater 4h after operation. Group Ⅲ VAS scores were the lowest 24h after operation. However, the number of times patients pressed the bolus switch was higher in group Ⅱ (P＜0.01). Conclusion: Compared with GA and intravenous PCA, general anesthesia combined with thoracic epidurai anesthesia and analgesia obtain better pain relief and could markedly alleviate the stress response and improve these erythrocyte glucose metabolism changes after esophagus surgery.