谷氨酰胺二肽对体外循环心脏手术患者肠粘膜屏障的保护作用

Effects of Dipeptiven on plasma Diamine oxidase,D-lactate and endotoxin in patients underwent cardiopulmonary bypass

目的探讨体外循环(CPB)心脏手术对患者肠粘膜屏障的影响以及谷氨酰胺二肽(力太)对肠粘膜屏障的保护作用。方法40例二尖瓣置换手术患者,随机分为对照组和力太组,力太组患者在手术当天和术后第1天给予力太,按体重0.5mg/kg静脉输入。检测围术期患者血浆D-乳酸、二胺氧化酶(DAO)、内毒素含量,进行统计学分析。结果2组病例体外循环(CPB)开始后的上述指标均高于术前(P<0.05),力太组在CPB开始后的各时相点,上述指标均明显低于对照组(P<0.05)。结论体外循环对心脏手术患者的肠粘膜屏障有损害,外源性丙氨酸-谷氨酰胺二肽(力太)对患者肠粘膜屏障有一定的保护作用。

Objective To study the effects of cardiopulmonary bypass （CPB） on the intestinal barrier and the protective roles of Dipeptive on the intestinal mucosal barrier. Methods Forty patients underwent mltral valve replacement with CPB were randomly divided into 2 groups： the control group and the Dipeptive group. Dipeptiven at 0.5 mg/kg was administrated to the patients in Dipeptive group during operation and in the first postoperative day. Plasma levels of diamine oxidase（ DAO）, D-lactate and endotoxin were measured before operation and at 20min during CPB, the end of CPB, in 24 h, 48 h after operation. Results Plasma diamine oxidase, D-lactate and endotoxin during CPB and at the postoperative time points were significantly higher than those of the pre-operation in the two groups. However, the plasma level of diamine oxidase, D-lactate and endotoxin of the Dipeptive group were much lower than those of control group at the postoperative time points. Conclusion CPB can induce the damage to the intestinal mucosal barrier. Dipeptiven （Alanyl-Glutamine） might be a useful agent to protect the intestinal mucosal barrier in patients underwent CPB.