摘要
目的:探讨静脉滴注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:选取2015年8月至2016年6月重庆大学附属肿瘤医院收治的择期行胃癌、结直肠癌根治术患者60例,采用随机数字表法分为观察组和对照组,每组30例。观察组患者分别于术前和术后2 d静脉滴注N(2)-L-丙氨酰-L-谷氨酰胺注射液(0.4 g/kg);对照组患者于同时间点静脉滴注等体积的复方氨基酸注射液(20AA)。两组患者分别在麻醉诱导前、诱导后、术毕和术后第1、3及7日空腹条件下采静脉血,测定血糖(BG)、胰岛素(INS)、胰高血糖素(GC)、皮质醇(Cor)、活性氧(ROS)、谷胱甘肽(GSH)和氧化型谷胱甘肽(GSSG)含量。计算胰岛素抵抗指数(HOMA-IR)和GSH/GSSG。结果:与麻醉诱导前比较,观察组患者BG、INS、ROS水平和HOMA-IR仅在术毕时明显升高,差异均有统计学意义(P<0.05);而对照组患者在麻醉诱导后至术后第3日均出现明显升高,差异有统计学意义(P<0.05);麻醉诱导后至术后第3日,观察组患者BG、INS、ROS水平和HOMA-IR明显低于对照组,差异均有统计学意义(P<0.05)。麻醉诱导后至术后第3日,两组患者GC、Cor水平均较诱导前明显升高,但两组的差异无统计学意义(P>0.05)。与麻醉诱导前比较,对照组患者麻醉诱导后至术后第3日血浆GSH/GSSG明显降低,差异有统计学意义(P<0.05);观察组患者各时间点血浆GSH/GSSG的差异均无统计学意义(P>0.05)。麻醉诱导后至术后第3日,观察组患者GSH/GSSG明显高于对照组同一时间点,差异均有统计学意义(P<0.05)。观察组患者首次排气时间、切口感染发生率明显低于对照组,差异均有统计学意义(P<0.05)。两组患者心律失常、尿路感染、肺部感染和吻合口瘘发生率的差异均无统计学意义(P>0.05)。两组无患者出现急性心肌梗死、心力衰竭、呼吸功能不全、腹膜炎、脓毒血症和肠梗阻。结论:
OBJECTIVE:To investigate the effects and possible mechanism of intravenous N(2)-L-alanyl-L-glutamine on postoperative insulin resistance in patients undergoing gastrointestinal surgery.METHODS:Totally 60 patients undergoing radical surgery for gastric cancer and colorectal cancer admitted into Chongqing University Cancer Hospital from Aug.2015 to Jun.2016 were extracted to be divided into the observation group and the control group via the random number table,with 30 cases in each group.Patients in the observation group received N(2)-L-alanyl-L-glutamine injection(0.4 g/kg)intravenously before and 2 d after surgery,while the control group were injected with equal volume of compound amino acid injection(20AA)at the same time.Venous blood was collected from patients in two groups,and the blood glucose(BG),insulin(INS),glucagon(GC),cortisol(Cor),reactive oxygen species(ROS),glutathione(GSH)and oxidized glutathione(GSSG)were measured before and after induction,at the first,third and seventh day after surgery,and after surgery.HOMA-IR and GSH/GSSG were calculated.RESULTS:Compared with before induction,the levels of BG,INS,ROS and HOMA-IR in the observation group were significantly increased only at the end of surgery,and the differences were statistically significant(P<0.05).The control group showed significant increase from the induction to the third day after surgery,and the difference was statistically significant(P<0.05).From induction to the third day after surgery,the levels of BG,INS,ROS and HOMA-IR in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).From induction to the third day after surgery,the levels of GC and Cor in two group were significantly higher than that before the induction,but the difference between two groups was not statistically significant(P>0.05).Compared with before induction,the plasma GSH/GSSG decreased significantly in the control group from induction to 3 days after surgery,and the difference was statistic
作者
刘海霞
蒋燕
罗敏
LIU Haixia;JIANG Yan;LUO Min(Dept.of Medical Abministration,Chongqing University Cancer Hospital,Chongqing Key Laboratory of Tumor Metastasis and Individualized Diagnosis and Treatment,Chongqing 400030,China;Dept.of Anesthesiology,Chongqing University Cancer Hospital,Chongqing 400030,China;Dept.of Medical Abministration,Chongqing University Cancer Hospital,Chongqing 400030,China)
出处
《中国医院用药评价与分析》
2019年第10期1179-1182,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
重庆市卫生局医学科研面上项目(No.2013-2-123)
