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目的观察外源性补充谷氨酰胺(Gln)对先天性心脏病手术患儿血清乳酸(LD)和神经特异性元烯醇化酶(NSE)水平的影响。方法将2011年9月至2014年9月68例先天性心脏病心内直视手术患儿抽签随机分为观察组与对照组,各为34例,观察组术前给予氨基酸加Gln二肽1∶4配制微量泵输注给药,对照组术前采取氨基酸加生理盐水1∶4配制微量泵输注给药,比较两组术前30min(T0)、开放主动脉后10min(T1)、体外循环后1h(T2)、体外循环后6h(T3)、体外循环后24h(T4)LD及NSE水平,分光光度比色法检测LD水平,双抗体夹心法检测标本内NSE水平。结果两组T0时比较无统计学意义(P>0.05),对照组T1~T4时LD分别为(4.51±0.61)mmol/L、(4.31±0.85)mmol/L、(4.23±0.61)mmol/L、(5.22±0.91)mmol/L,与观察组(2.77±1.42)mmol/L、(3.74±0.85)mmol/L、(2.53±1.94)mmol/L、(3.62±1.31)mmol/L比较显著增高(P<0.05);对照组T3时NSE为(15.34±3.17)μg/L,与观察组(10.62±5.03)μg/L比较显著增高,差异有统计学意义(P<0.05)。结论外源性补充Gln对先天性心脏病手术患儿脑功能有一定保护作用,其机制考虑与降低血清LD及NSE水平有关。
Objective To investigate the effect of exogenous glutamine supplementation on serum lactate (LD) and neuron specific enolase (NSE) levels in children with congenital heart disease. Methods From September 2011 to September 2014, 68 children with open heart surgery under congenital heart disease undergoing open heart surgery were randomly divided into observation group and control group, with 34 cases in each group. The patients in observation group were given amino acid plus Gln dipeptide 1 : 4 preparation of micro-pump infusion, the control group before taking amino acids plus saline 1: 4 preparation of micro-pump infusion, 30min (T0), 10min after the opening of the aorta (T1), in vitro The levels of LD and NSE were measured at 1 hour (T2), 6 hours after cardiopulmonary bypass (6 hours) and 24 hours after cardiopulmonary bypass (T4). LD levels were measured by spectrophotometry and NSE levels by double antibody sandwich method. Results There was no significant difference in T0 between the two groups (P> 0.05). The LD of T1 ~ T4 in the control group were (4.51 ± 0.61) mmol / L, (4.31 ± 0.85) mmol / (5.22 ± 0.91) mmol / L and (2.77 ± 1.42) mmol / L, (3.74 ± 0.85) mmol / L and (2.53 ± 1.94) mmol / L and (P <0.05). The NSE in the control group at T3 was (15.34 ± 3.17) μg / L, which was significantly higher than that in the observation group (10.62 ± 5.03) μg / L, the difference was statistically significant (P <0.05). Conclusions Exogenous glutamine supplementation may have a protective effect on brain function in children with congenital heart disease. The mechanism is considered to be related to the lowering of serum LD and NSE level.