谷氨酸胺对胃肠道手术患者术后胰岛素抵抗的影响

发布时间：2018-08-27 19:36

【摘要】：目的:探讨静脉给予N(2)-L-丙氨酰-L-谷氨酰胺对胃肠道手术患者术后胰岛素抵抗的影响及其可能的机制。方法:1.实验对象选择。选择医院择期进行胃癌、结肠癌、直肠癌三种癌症根治术的患者,共取60例,年龄在35~75岁之间,不限性别。选择患者条件范围为:体重指数BMI为18.5~25 kg/m2,ASA I~II级,随机分配为2组(n=30)。实验组,即谷氨酰胺组(按照谷氨酰胺glutamine将该组简称为G组),分别于术前1h、术后1d和2d静脉输注N(2)-L-丙氨酰-L-谷氨酰胺(0.4g/Kg/d,溶于五倍体积的复方氨基酸20AA中);对照组(按照对照组control group简称该组为C组)于术前1h、术后1d和2d静脉输注相同体积复方氨基酸20AA。2.实验方法。静脉血的采集时间分别定于麻醉诱导前(T1)、麻醉诱导后(T2)、手术结束时(T3)、手术后第1天(T4)、手术后第3天(T5),以及手术后第7天(T6)采取(需在空腹条件下采集),采集的静脉血用于TNF-α、血糖(BG)、皮质醇(Cor)、血清胰岛素(INS)、胰高血糖素(IRG)、ROS水平,及血浆T-AOC含量、GSH、GSSG的测定。术后记录患者心血管并发症(即心律失常、急性心梗、心衰)、肺部并发症(即肺炎、呼吸功能不全)、感染并发症(即腹膜炎、吻合口瘘、切口感染、脓毒血症、尿路感染)、胃肠道功能情况(即首次排气时间、肠梗阻)。结果:1.G组和C组患者比较差异方面无统计学意义(即P0.05)的指标有:年龄、体重指数、性别、手术时间出血量、术后疼痛评分和输液总量。2.与麻醉前比较,谷氨酰胺组仅在术毕时出现血糖、血清胰岛素、HOMA-IR、ROS升高及ISI降低(P0.05);而对照组在麻醉后至术后第3天均出现了各指标的相应变化(即P0.05)。与进行麻醉前相比,对照组和谷氨酰胺组血清胰高血糖素素和皮质醇水平在麻醉后至术后第3天均发生了明显增高(P0.05);但两组同一时间点比较无明显差异。与麻醉前数据进行比较,对照组血清TNF-α水平在术毕至术后第3天明显增高(P0.05),而谷氨酰胺组的数据被观察到在手术结束正当时和手术后的第1天显著增高(P0.05);与麻醉前比较,对照组血浆GSH水平在术毕至术后第3天明显降低(P0.05),而在麻醉后至术后第3天GSSG水平明显增高(P0.05),GSH/GSSG及T-AOC却明显降低(P0.05);但谷氨酰胺组在相应时间点未观察到明显变化(P0.05)。与对照组的数据进行比较后发现,谷氨酰胺组从术毕至术后第3天GSH水平明显升高,在麻醉后到术后第3天,血糖、血清胰岛素、HOMA-IR、ROS及GSSG水平均明显降低,ISI、GSH/GSSG及T-AOC显著上升(P0.05)。3.术后观察发现,与对照组比较,谷氨酰胺组首次排气时间、切口感染发生率明显降低(P0.05)。两组心律失常、肺部炎症、尿路感染和吻合口瘘的发生率的比较性差别均显示出了无统计学意义现象(P0.05)。结论:1.围术期静脉给予N(2)-L-丙氨酰-L-谷氨酰胺可降低胃肠道手术患者术后胰岛素抵抗的程度和持续时间。2.围术期静脉给予N(2)-L-丙氨酰-L-谷氨酰胺可促进胃肠道手术患者术后恢复,降低并发症。3.N(2)-L-丙氨酰-L-谷氨酰胺改善术后胰岛素抵抗及促进术后恢复的机制,可能与其提高抗氧化能力、维持机体氧化还原稳态有关。
[Abstract]:Objective:To investigate the effect of intravenous N(2)-L-alanyl-L-glutamine on postoperative insulin resistance in patients undergoing gastrointestinal surgery and its possible mechanism.Methods:1.Selection of subjects.Sixty patients with gastric, colon and rectal cancers who underwent elective radical resection in our hospital were selected, aged between 35 and 75 years, regardless of gender. The BMI ranged from 18.5 kg/m2 to 25 kg/m2, ASA I~II, and was randomly assigned to two groups (n=30). The experimental group, glutamine group, was given intravenous infusion of N(2)-L-alanyl-L-glutamine (0.4 g/Kg/d, dissolved in 5-fold volume of compound amino acid 20AA) one hour before operation, one day and two days after operation, respectively. The control group was given the same volume of compound amino acid 20AA.2 intravenously one hour before operation, one day and two days after operation. The time of venous blood collection was set before anesthesia induction (T1), after anesthesia induction (T2), at the end of operation (T3), on the first day (T4), on the third day (T5) and on the seventh day after operation. On day T6, venous blood samples were taken for TNF-alpha, blood glucose (BG), cortisol (Cor), serum insulin (INS), glucagon (IRG), ROS, and plasma T-AOC levels, GSH, and GSSG measurements. Cardiovascular complications (i.e. arrhythmia, acute myocardial infarction, heart failure), pulmonary complications (i.e. pneumonia, respiratory failure) were recorded after surgery. The complications of infection (peritonitis, anastomotic fistula, incision infection, sepsis, urinary tract infection), gastrointestinal function (i.e. the first exhaust time, intestinal obstruction). Results: 1. There was no significant difference between G group and C group (P Compared with the pre-anesthesia group, glutamine group only showed blood glucose, serum insulin, HOMA-IR, ROS elevation and ISI decrease at the end of operation (P 0.05); while the control group showed corresponding changes in each index from the post-anesthesia to the third day after operation (P 0.05). The serum levels of TNF-alpha in the control group were significantly higher from the end of the operation to the third day after the operation (P 0.05), while those in the glutamine group were observed at the right time after the operation and the hands. Compared with pre-anesthesia group, the plasma GSH level in control group decreased significantly from the end of operation to the third day after operation (P 0.05), and increased significantly from post-anesthesia to the third day after operation (P 0.05), while GSH / GSSG and T-AOC decreased significantly (P 0.05); however, no significant changes were observed in glutamine group at the corresponding time points (P 0.05). Compared with the control group, the GSH level in the glutamine group increased significantly from the end of operation to the third day after operation. From the end of anesthesia to the third day after operation, the blood glucose, serum insulin, HOMA-IR, ROS and GSSG levels were significantly decreased, while the ISI, GSH/GSSG and T-AOC levels were significantly increased (P 0.05). After operation, the first exhaust was observed in the glutamine group compared with the control group. There was no significant difference in the incidence of arrhythmia, pulmonary inflammation, urinary tract infection and anastomotic leakage between the two groups (P 0.05). Conclusion: 1. Perioperative intravenous administration of N (2) -L-alanyl-L-glutamine can reduce insulin resistance in patients undergoing gastrointestinal surgery. Perioperative intravenous administration of N(2)-L-alanyl-L-glutamine can promote postoperative recovery and reduce complications in patients undergoing gastrointestinal surgery. 3.
【学位授予单位】：重庆理工大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R656

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