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Background: Previous studies have found that, in patients undergoing upper abdominal or thoracic surgery, postoperative erythrocyte glucose metabolism specific changes, namely: the glycolytic pathway by inhibition of the pentose phosphate and polyol pathway is active. Compared with general anesthesia, surgery, anesthesia combined with epidural anesthesia can effectively mitigate this change. Postoperative erythrocyte glucose metabolism changes will extend the impact of their different postoperative analgesic, has not been reported yet. Objective: This study except intended to compare different anesthesia, focuses on postoperative analgesia for thoracotomy patients erythrocyte rate-limiting enzyme of glucose metabolism and stress hormone levels, provide a reference for clinical application. Methods: 62 patients undergoing elective esophageal surgery patients were randomly divided into three groups: group Ⅰ (n = 20) for intraoperative intravenous anesthesia, the postoperative intravenous fentanyl analgesia; Ⅱ group (n = 21) the intraoperative intravenous anesthesia composite epidural anesthesia, the postoperative intravenous fentanyl analgesia; intraoperative intravenous anesthesia combined with epidural block III group (n = 21), postoperative epidural ropivacaine mixed with fentanyl analgesic . Were before anesthesia (T 1 ), surgery 60 min (T 2 ), after surgery for 60 min (T 3 ), after d morning (T 4 ) and postoperative 2d morning (T 5 ) extracted peripheral venous blood, determination of the erythrocyte phosphofructokinase (PFK), glucose-6-phosphate de- catalase (G-6PD) and aldose reductase (AR) activity, and plasma glucose, norepinephrine, epinephrine and cortisol levels. Using a visual analog scale (VAS) to determine postoperative 4 h, 12h, 24 h, 48 h analgesic effect and record the total number of pressing analgesia pump. Results: (1) T 1 compared T 4 Ⅰ and Ⅱ patients PFK activity were significantly lower (P <0.01, P = 0.004), and I group, group II, Ⅰ group were also significantly lower (P = 0.044); Ⅲ patients PFK activity at this time no significant change compared with group Ⅰ, Ⅱ group, a significant difference (P <0.01, P = 0.018). (2) T 1 compared Ⅰ Ⅱ patients G-6PD and AR activity in T 4 were significantly higher (P <0.01), and the two comparison between groups, the the Ⅰ group increased more significantly (P = 0.020, P = 0.006), while no significant change in the activity of two enzymes III patients with T 4 point in time, with group Ⅰ, Ⅱ compared statistically significant (G-6PD P <0.01, P = 0.022; AR, P <0.01, P = 0.035). (3) the three groups of patients with blood glucose self-T 2 began to increase to T 4 peaked T 5 group Ⅲ patients blood sugar recovery to the preoperative level, T 4 and T , 5 when Ⅲ patients blood glucose than Ⅰ group, Ⅱ group was significantly lower (T 4 was P = 0.003, P = 0.044; T 5 P <0.01, P = 0.029). (4) T 2 group Ⅰ than Ⅱ, Ⅲ patients plasma epinephrine, norepinephrine concentration was significantly higher (P <0.01 or P <0.05), T 4 group III patients epinephrine and norepinephrine concentrations than group Ⅰ, group II patients was significantly lower (P <0.05). (5) of the three groups of patients cortisol levels were T 2 significantly increased to T 4 , reached the peak T 5 began to decline which T 2 T 3 point in time I group than in the group Ⅱ, Ⅲ group increased range is greater (P <0.05), T 4 , T 5 de facto group Ⅰ, Ⅱ group higher than group III cortisol levels, a significant difference (P <0.01 or P <0.05). (6) after 4h Ⅱ group by group VAS pain score than group Ⅰ, postoperative 24h Ⅲ VAS pain score than group Ⅰ, Ⅱ group was significantly lower, but the group II analgesic pump pressed significantly more often than the other two groups ( P <0.01). Conclusion: the thoracotomy esophageal surgery using general anesthesia combined with epidural block and postoperative epidural analgesia can inhibit blood sugar and stress hormone levels, reduce the perioperative stress response, improve erythrocyte sugar metabolic status. This is an ideal anesthetic and analgesic methods.
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