谷氨酰胺对小儿心内直视手术的神经元烯醇化酶的影响

The Effect of Glutamine on Neuron-Specific Enolase in Pediatric Open Heart Surgery

目的探讨谷氨酰胺(Gln)对先天性心脏病心内直视手术患儿的血清特异性神经元烯醇化酶(NSE)的影响和可能脑保护机制。方法将择期行体外循环(CPB)下先天性心脏病(VSD/ASD)心内直视手术患儿20例随机分为2组,小儿氨基酸+Gln组(G组)和小儿氨基酸+生理盐水组(P组),每组10例。2组患儿统一进行术前用药、麻醉诱导、麻醉维持、CPB以及术后管理。于术前30 min(T0)、主动脉开放后10 min(T1)以及CPB结束后1 h(T2)、6 h(T3)、24 h(T4)分别采集颈内静脉球部静脉血检测一氧化氮合酶(NOS)、乳酸(LD)和NSE水平变化。结果 2组血清学指标在T0时差异无显著性意义(P>0.05);T2-T4时间点NOS活性G组与P组比较有所上升、LD有所下降(P<0.05或P<0.01);NSE值G组在T3时点与P组比较在有所下降(P<0.05)。结论外源性补充Gln能够安全有效地调节先天性室间隔缺损/房间隔缺损心内直视手术患儿血清NOS活性,降低LD和NSE水平,具有一定的脑保护作用。

Objective To investigate the brain protection effect of glutamine on pediatric congenital heart disease undergoing open heart surgery by observing the level of neuron-specific enolase.Methods Twenty children with congenital heart disease（VSD or ASD） undergoing selective open heart surgery were randomly allocated into two groups：common intravenous nutrition group P（n=10） and glutamine intravenous nutrition group G（n=10）.It was the same in two groups for giving preoperative medication,anesthesia induction,anesthesia maintenance,cardiopulmonary bypass and postoperative management.Vein blood was collected at 30 minutes（T0） preoperative,at 10 minutes（T1） after open arteriae aorta,1 hour（T2）,6 hour（t3） and 24 hour（T4）after cardiopulmonary bypass.The levels of NOS,LD and NSE were detected at different time points.Results The general state of health between the two groups had no difference（P0.05）.The level of NOS of group G increased and LD decreased compared with that of group P at T2 to T4（P0.05 or P0.01）;The level of NSE of group G was declined compared with group P at T3（P0.05）.Conclusion Supply exogenous glutamine is safe and effective in pediatric congenital heart disease of interventricular septal defect/ atrial septal defect undergoing open heart surgery,and regulate the serum level of NOS and degrade the serum level of LD and NSE,which maybe have brain protection.