谷氨酸胺對胃腸道手術(shù)患者術(shù)后胰島素抵抗的影響
發(fā)布時間：2018-08-27 19:36
【摘要】：目的:探討靜脈給予N(2)-L-丙氨酰-L-谷氨酰胺對胃腸道手術(shù)患者術(shù)后胰島素抵抗的影響及其可能的機制。方法:1.實驗對象選擇。選擇醫(yī)院擇期進行胃癌、結(jié)腸癌、直腸癌三種癌癥根治術(shù)的患者,共取60例,年齡在35~75歲之間,不限性別。選擇患者條件范圍為:體重指數(shù)BMI為18.5~25 kg/m2,ASA I~II級,隨機分配為2組(n=30)。實驗組,即谷氨酰胺組(按照谷氨酰胺glutamine將該組簡稱為G組),分別于術(shù)前1h、術(shù)后1d和2d靜脈輸注N(2)-L-丙氨酰-L-谷氨酰胺(0.4g/Kg/d,溶于五倍體積的復方氨基酸20AA中);對照組(按照對照組control group簡稱該組為C組)于術(shù)前1h、術(shù)后1d和2d靜脈輸注相同體積復方氨基酸20AA。2.實驗方法。靜脈血的采集時間分別定于麻醉誘導前(T1)、麻醉誘導后(T2)、手術(shù)結(jié)束時(T3)、手術(shù)后第1天(T4)、手術(shù)后第3天(T5),以及手術(shù)后第7天(T6)采取(需在空腹條件下采集),采集的靜脈血用于TNF-α、血糖(BG)、皮質(zhì)醇(Cor)、血清胰島素(INS)、胰高血糖素(IRG)、ROS水平,及血漿T-AOC含量、GSH、GSSG的測定。術(shù)后記錄患者心血管并發(fā)癥(即心律失常、急性心梗、心衰)、肺部并發(fā)癥(即肺炎、呼吸功能不全)、感染并發(fā)癥(即腹膜炎、吻合口瘺、切口感染、膿毒血癥、尿路感染)、胃腸道功能情況(即首次排氣時間、腸梗阻)。結(jié)果:1.G組和C組患者比較差異方面無統(tǒng)計學意義(即P0.05)的指標有:年齡、體重指數(shù)、性別、手術(shù)時間出血量、術(shù)后疼痛評分和輸液總量。2.與麻醉前比較,谷氨酰胺組僅在術(shù)畢時出現(xiàn)血糖、血清胰島素、HOMA-IR、ROS升高及ISI降低(P0.05);而對照組在麻醉后至術(shù)后第3天均出現(xiàn)了各指標的相應(yīng)變化(即P0.05)。與進行麻醉前相比,對照組和谷氨酰胺組血清胰高血糖素素和皮質(zhì)醇水平在麻醉后至術(shù)后第3天均發(fā)生了明顯增高(P0.05);但兩組同一時間點比較無明顯差異。與麻醉前數(shù)據(jù)進行比較,對照組血清TNF-α水平在術(shù)畢至術(shù)后第3天明顯增高(P0.05),而谷氨酰胺組的數(shù)據(jù)被觀察到在手術(shù)結(jié)束正當時和手術(shù)后的第1天顯著增高(P0.05);與麻醉前比較,對照組血漿GSH水平在術(shù)畢至術(shù)后第3天明顯降低(P0.05),而在麻醉后至術(shù)后第3天GSSG水平明顯增高(P0.05),GSH/GSSG及T-AOC卻明顯降低(P0.05);但谷氨酰胺組在相應(yīng)時間點未觀察到明顯變化(P0.05)。與對照組的數(shù)據(jù)進行比較后發(fā)現(xiàn),谷氨酰胺組從術(shù)畢至術(shù)后第3天GSH水平明顯升高,在麻醉后到術(shù)后第3天,血糖、血清胰島素、HOMA-IR、ROS及GSSG水平均明顯降低,ISI、GSH/GSSG及T-AOC顯著上升(P0.05)。3.術(shù)后觀察發(fā)現(xiàn),與對照組比較,谷氨酰胺組首次排氣時間、切口感染發(fā)生率明顯降低(P0.05)。兩組心律失常、肺部炎癥、尿路感染和吻合口瘺的發(fā)生率的比較性差別均顯示出了無統(tǒng)計學意義現(xiàn)象(P0.05)。結(jié)論:1.圍術(shù)期靜脈給予N(2)-L-丙氨酰-L-谷氨酰胺可降低胃腸道手術(shù)患者術(shù)后胰島素抵抗的程度和持續(xù)時間。2.圍術(shù)期靜脈給予N(2)-L-丙氨酰-L-谷氨酰胺可促進胃腸道手術(shù)患者術(shù)后恢復,降低并發(fā)癥。3.N(2)-L-丙氨酰-L-谷氨酰胺改善術(shù)后胰島素抵抗及促進術(shù)后恢復的機制,可能與其提高抗氧化能力、維持機體氧化還原穩(wěn)態(tài)有關(guān)。
[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.
【學位授予單位】：重慶理工大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R656
本文編號：2208242
[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.
【學位授予單位】：重慶理工大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R656
【參考文獻】
相關(guān)期刊論文 前7條
1 ;Effects of Glutamine Supplementation on Patients Undergoing Abdominal Surgery[J];Chinese Medical Sciences Journal;2009年01期
2 ;Glutamine dipeptide for parenteral nutrition in abdominal surgery:A meta-analysis of randomized controlled trials[J];World Journal of Gastroenterology;2006年46期
3 萬獻堯;畢麗巖;張永利;;谷氨酰胺對銅綠假單胞菌所致肺部感染大鼠的防護作用[J];中華內(nèi)科雜志;2006年12期
4 樊躍平;于健春;康維明;張群;;谷氨酰胺雙肽強化的腸外營養(yǎng)對腹部手術(shù)患者谷胱甘肽水平的影響[J];中華外科雜志;2005年21期
5 朱嶺,彭開勤,全卓勇,龔少敏,張應(yīng)天;胰島素抵抗與手術(shù)創(chuàng)傷程度關(guān)系的臨床研究[J];中華外科雜志;2005年15期
6 張雁,孫家邦,李非;外科術(shù)后胰島素抵抗[J];首都醫(yī)科大學學報;2002年03期
7 秦環(huán)龍;外科嚴重創(chuàng)傷時的代謝改變及營養(yǎng)支持[J];腸外與腸內(nèi)營養(yǎng);1999年01期
相關(guān)碩士學位論文 前1條
1 賈建昌;平衡補益系列方劑調(diào)節(jié)運動性疲勞血睪酮水平的作用及機理研究[D];山東中醫(yī)藥大學;2006年
，本文編號：2208242
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2208242.html
最近更新
教材專著
