【摘要】 目的 观察术前输入葡萄糖对胸科病人手术前、后骨骼肌葡萄糖转运蛋白4基因(Glut-4 mRNA)表达的影响。方法择期食管癌根治手术病人12例,随机分为常规禁食组(Ⅰ组)和输入葡萄糖组(Ⅱ组),分别于进胸和关胸时各取第8肋间骨骼肌1 g;用TRlzol一步法提取骨骼肌细胞总RNA,通过RT-PCR方法,获得Glut-4 mRNA扩增产物;每例表达值以目的基因/β-actin×100％表示,同时测定进胸和关胸时血糖和胰岛素。结果 与进胸时相比较,关胸时Glut-4 mRNA表达值均明显降低(P<0.05),血糖明显升高(P<0.05);但关胸时Ⅱ组Glut-4 mRNA表达值明显高于Ⅰ组(P<0.01)。结论 术前输入一定量葡萄糖可减轻术后Glut-4 mRNA表达受抑制程度,缓解术后胰岛素抵抗现象。更多还原

【Abstract】 Objective The purpose of this study was to examine the effect of preoperative glucose infusion on glucose transport-4 mRNA ( Glut-4 mRNA) expression in skeletal muscle before and after thoracic operation. Methods Twelve male ASA Ⅰ - Ⅱ patients undergoing elective radical surgery for esophagus cancer were randomly divided into 2 groups : (Ⅰ ) control group; (Ⅱ) glucose infusion group. Patients with hypertension, hyperlipidemia or diabetes mellitus were excluded. The patients in both groups were premedicated with phenobarbitol and atropine. Anesthesia was induced with midazolam 0.1 mg · kg-1 , propofol 1.5 mg ·kg-1 , fentanyl 4μg·kg-1 and vecuronium 0.15 mg·kg-1 . The patients were mechanically ventilated after trachea! intubatioa Anesthesia was maintained with continuous iv infusion of propofol (80μg · kg-1· min-1 ) and vecuronium (1.0 μg·kg-1·min-1) supplemented with droperidol 0.1 mg·kg-1 and fentanyl 6 μg ·kg-1 given in several boluses. In group Ⅱ 5 % glucose (0.25 g·kg-1) was infused 2 h before operation. Blood samples and 1 g of skeletal muscle were obtained while chest was being opened and closed for determination of plasma glucose and insulin levels and Glut-4 mRNA expression in muscle. The total RNA of the muscle cells was extracted by trizol one-step template. The Glut-4 mRNA amplification products were determined using RT-PCR with β-action mRNA as an internal control. The Glut-4 mRNA expression was expressed by desired gene/ β-action× 100% .Results Glut-4 mRNA expression was significantly decreased ( P < 0.05) and plasma glucose level significantly increased (P < 0.05) while chest was being closed as compared with the values determined while chest was being opened. Glut-4 mRNA expression determined while chest was being closed was significantly higher in group Ⅱ than that in group Ⅰ ( P < 0.01). Conclusion The results indicate that synthesis of Glut-4 is suppressed by the stress induced by thoracic operation performed under general anesthesia. Preoperative glucose infusion can attenuate the suppression of Glut-4 mRNA expression induced by surgery and postoperative insulin resistance.更多还原