Comparison Of Different Anesthesias And Analgesias On The Effects Of Glycometabolism Rate-limiting Enzymes In Erythrocytes And The Plasma Glucose And Stress Hormones In Patients Undergoing Esophagectomy Surgery

Background: Our previous study found the activities of phosphofructokinase( PFK )in erythrocytes depressed , while the activities of glucose-6-phasphate dehydrogenase ( G-6PD) and aldose reductase (AR) significantly activated on 1st postoperative day in patients after esophagectomy surgery. comparing pure genenal anesthesia, General anesthesia combined with thoracic epidural anesthesia could moderate these enzymes activities changes .We had no knowledge of different patient controlled analgesias on the effects of these enzymes activities.Objective: Except different anesthesias, to compare thoracic epidural analgesia with intravenous patient controlled analgesia on the activities of PFK, G-6PD and AR in erythrocytes and the plasma levels of glucose and stress hormones in patients undergoing esophagectomy surgery. Methods : Sixty-two patients scheduled for esophagectomy were randomly divided into three groups: group I (n=20) receiving only genaral anesthesia followed by intravenous patient controlled analgesia with fentanyl 15μg /kg, The two other groups both receiving general anesthesia combined with thoracic epidural anesthesia and either intravenous patient controlled analgesia with fentanyl 15μg /kg (group II ,n=21) or thoracic epidural analgesia with 0.125 % Ropicaine and 0.0002 % fentany (group III ,n=21) after operation. Venous blood samples were collected for the measurement of PFK,G-6PD and AR activities in erythrocytes and the plasma levels of glucose,cortisol,epinephrine and norepinephrine before induction(T₁),at 60min following the incision(T₂),60mm(T₃)after operation,on the 1st (T₄)and 2nd postoperative day(T₅).Results: Compared with these at T₁ ,the activity of PFK was decreased significantly (P < 0.01 or P = 0.004) and the activities of G-6PD and AR were increased markedly ( P < 0. 01) on T₄ in group I and II. Between the two groups,the activities of these enzymes in group II changed less than that of group I (P <0.01 or P <0.05). these enzymes activity slightly changed in group III on T₄(P > 0.05).There were markedly differences between group III and other two groups (P <0.05 or P <0.01). The levels of plasma glucose elevated significantly on T₂ (P <0.01) , reached high peak values on T₄ ( P < 0.01)and failed on T₅ in three groups .comparing to those of group I and II ,The values of plasma glucose in group III were significantly lower on T₄ and T₅ (P < 0.05 or P <0.01). The cortisol concentration in each group increased significantly at T₂ (P <0.01 or P <0.05 ),still kept at high levels on T₅( P <0.01 or P <0.05 ),while on T₂ and T₃ the cortisol levels of group I were markedly higer than that of group II and III (P < 0.05).and the levels of group III were significantly lower than those of other groups on T₄ and T₅( P <0.01 or P <0.05 ) .It was also occurred to epinephrine and norepinephrine that the levels were much higher in group I than those of other two groups on T₂ (P <0.01 or P <0.05 ) .and the levels of group I and II were markedly higher than that of group III on T₄. The patients of three groups obtained satisfied pain relief, all Vidual Analogue Scale (VAS) < 3. VAS of group I was much greater at 4h after operation. VAS of group III was smallest at 24h after operation. But the number of times patients pressed the bolus switch was higher in group II (P < 0.01).Conclusion: Compared with general anesthesia and intravenous analgesia, general anesthesia combined with epidural anesthesia and analgesia could markedly allevate stress response and have better pain relief so that improve these erythrocyte glucose metabolism changes after esophageal surgery.