谷氨酰胺对体外循环患者肠道保护作用的临床的研究.docVIP

谷氨酰胺对体外循环患者肠道保护作用的临床研究 作者：刘小雄,彭金华,徐建军 作者单位：江西省中医院胸外科，南昌大学第二附属医院胸外科，江西 南昌 330006 【摘要】 目的 观察体外循环（extracorporeal circulation,ECC）患者接受谷氨酰胺(glutamine, Gln)治疗后血清二胺氧化酶(diamine oxidase, DAO )、肿瘤坏死因子(tumor necrotic factor, TNF-Α)水平的变化，以初步阐明Gln促进ECC患者肠粘膜损伤修复的机制。方法 将24名ECC患者随机分成Gln组(n=12)和对照组(n=12)， Gln组ECC前一周开始口服麦滋林颗粒，剂量为0.50 g/（kg·day），对照组给予安慰剂。两组病例均按常规进行ECC术，分别于术前7天,ECC后2 h,24 h,72 h抽外周静脉血5毫升。生化法检测血清DAO浓度，酶联免疫吸附实验(enzyme linked immunosorbent assay,ELISA)检测血清TNF-Α浓度。结果 两组患者的血清DAO、TNF-Α水平在ECC前无统计学意义（P＞0.05），ECC后升高（P＜0.05），并于2 h达到峰值,而后下降。DAO于ECC后72h仍然高于术前，TNF-Α则恢复到术前。Gln组DAO、TNF-Α在ECC后2 h、24 h均较对照组降低 （P＜0.05）。结论 ECC可引起患者血清DAO、TNF-Α升高，提示ECC可导致肠道损伤，Gln可以在一定程度上降低ECC患者血清DAO、 TNF-Α水平，促进肠粘膜损伤的修复。 【关键词】 体外循环；谷氨酰胺；二胺氧化酶；肿瘤坏死因子；肠粘膜损伤 　　Protective Effects of Glutamine on the Intestinal Mucosal Injury in Patients Undergoing Extracorporeal Circulation 　　LIU Xiao-xiong,PENG Jin-hua,XU Jian-jun，LEI Wei-cheng 　　(Department of Thoracic Surgery,The TCM Hospital of Jiangxi Province；The Second Affiliated Hospital of NanChang University,Jiangxi Nanchang 330006,China) 　　Abstract: OBJECTIVE To observe the changes of plasmic level of diamine oxidase (DAO) and tumor necrotic factor (TNF- Α) happened after L-Glutamine (Gln) used orally in the patients undergoing extracorporeal circulation (ECC) and discuss the mechanism of protective effects of Gln on intestinal mucosal injury caused by ECC. METHODS 24 patients undergoing ECC were divided randomly into two groups: Gln group(n=12) and control group (n=12).In Gln group,marzutene-s granules (Gln) ( 0.50g/(kg·day)) was given for seven days before ECC. While the control group received placebo. Plasmic levels of DAO and TNF- Α were measured at baseline (seven days preoperatively) and 2hours,24hours,72hours after ECC.The plasmic concentrations of DAO were detected by biochemical method, of TNF-Α by enzyme linked immunosorbent assay (ELISA) technique. RESULTS Levels of DAO and TNF- Α were no significant difference in