| Background: Stress hyperglycaemia and insulin resistance were often occurred in intraoperation and postoperation in patients undergoing thoracic and upper abdomen surgery. Glycolysis in erythrocyte was depressed overally in that period. Epidural block combined with general anesthesia could lighten effectively the special change of glycometabolism in erythrocyte caused by surgery stress. However, if some patients are unfit to receive epidural block, how to regulate it? It is known that exogenous insulin can degrade the elevated blood glucose. Actovegin, which act as parainsulin, can improve energy metabolism and promote glucose uptake and utilization in cell. So, it is assumed that whether the use of actovegin before anesthesia could intervene hyperglycemia caused by surgery stress.Objective: In order to investigate the effects of actovegin administrated before anesthesia on blood glucose, plasma insulin and erythrocytes glycolysis rate-limited enzyme [phosphofructokinase (PFK)] activities, and so on, in patients undergoing esophagus surgery.Methods: Sixty patients scheduled for esophagus surgery were randomly divided into three groups. The patients in control group received isoflurane inhalation general anesthesia and maintained with 1.2 MAC end-tidal concentration. The anesthesia method in actovegin group was same as control group, but actovegin(20 mg/kg) was administrated intravenously 30 min before anesthesia in actovegin group. The patients in epidural group received thoracic epidural block combined with isoflurane inhalation general anesthesia and maintained with 0.8 MAC end-tidal concentration. Blood samples were taken from peripheral vein for determination of blood glucose(BG), plasma insulin(INS), plasma lactic acid(LC), erythrocytes PFK activity, plasma norepinephrine (NEP), epinephrine(EP) and cortisol(COR) and insulin sensitivity index(ISI) was calculated. Samples were obtained 30 minitues before anesthesia (T1), 90 minutes after the start of surgery(T2), 60 minutes after the end of surgery(T3),first postoperative day morning(T4) and second postoperative day morning(TS).Results: (1) In each group, BG levels increased significantly (P＜0.01) from T2 compared with those at T1. At T3, BG levels were significantly lower(P=0.034, P=0.007) in actovegin and epidural group than those in control group. (2) INS concentrations in control group increased significantly(P=0.003) at T4 compared with those at T1, but at the same time point there was no significant difference(P＞0.05) in other groups. At T4, INS concentrations were significantly lower (P=0.040, P=0.035) in actovegin group and epidural group than those in control group. (3) In each group, ISI values decreased significantly(P＜0.05) at T4 compared with those at T1. At T4, ISI values were significantly higher(P=0.042, P=0.024) in actovegin and epidural group than those in control group. (4) PFK activities in control group decreased significantly (P=0.001) at T4 compared with that at T1, but at the same time point there was no significant difference(P＞0.05) in other groups. PFK activities were significantly higher(P=0.044, P=0.043) at T4 in actovegin and epidural group than those in control group. (5) LC concentrations in actovegin group were not changed significantly(P＞0.05) at T3 compared with those at T1, but at the same time point LC concentrations increased significantly (P=0.006, P=0.000) in other groups. At T4, LC concentrations were significantly lower(P=0.036) in actovegin group than those in control group. (6) NEP and EP levels increased significantly (P＜0.01) in actovegin and control group at T3 compared with those at T1, and there was no significant difference(P＞0.05) between two groups. At the same time point NEP and EP levels in epidural group did not changed significantly(P＞0.05) and were significantly lower than those in control group (P=0.004, P=0.015 ) and actovegin group(P=0.014, P=0.020). (7) In each group, COR levels were increased significantly (P＜0.01) at T4 compared with those aat T1. There was no significant difference(P＞0.05) at the same tipme poimt in COR levels between actovegin and control group, but COR levels in epidural group were significantly lower(P=0.042) than those in control group.Conclusion: It was analogic effect in actovegin and epidural block combined with general anesthesia that improvement of erythrocytes PFK activity and lightening hyperglycaemia and insulin resistance caused by stress in patients undergoing esophagus surgery. However, the regulation mechanism of actovegin was different with that of epidural block combined with general anesthesia. Epidural block could attenuate sympathesis tension and stress hormone, but actovegin could act as parainsulin, which improved glucose uptake and utilization in cell. Inadditon, it was still exist that hyperglycemia and insulin resistance in first and second day after operation, which was needed to be studied further.
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