中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
7期
785-788
,共4页
崔彦%胡柳%刘月江%吴亚谋%景亮
崔彥%鬍柳%劉月江%吳亞謀%景亮
최언%호류%류월강%오아모%경량
谷氨酰胺%胰岛素抗药性%结肠肿瘤
穀氨酰胺%胰島素抗藥性%結腸腫瘤
곡안선알%이도소항약성%결장종류
Glutamine%Insulin resistance%Colonic neoplasms
目的 评价N(2)-L-丙氨酰-L-谷氨酰胺对结肠癌患者围术期胰岛素抵抗的影响.方法 择期行结肠癌根治术的非糖尿病患者60例,年龄35～75岁,BMI 18.5～25.0 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其随机分为3组(n=20):对照组(C组)于术前24h、术后1h静脉输注生理盐水22.5 ml/kg；载体溶液组(V组)于术前24h、术后1h静脉输注复方氨基酸22.5 ml/kg；药物治疗组(Ala-Gln组)于术前24h、术后1h静脉输注N(2)-L-丙氨酰-L-谷氨酰胺(含谷氨酰胺0.5 g/kg,溶于复方氨基酸)22.5 ml/kg.于术前24 h(T)、麻醉前30 min(T2)、麻醉给药后3 h(T3)、术后1 h(T4)和24 h(T5)时空腹条件下采集静脉血样,测定血糖(BG)、血清胰岛素(INS)、TNF-α、游离脂肪酸(FFA)的浓度,计算胰岛素抵抗指数(HOMA-IR)及胰岛索敏感指数(ISI).记录术后的排气时间、住院时间及用药后胰岛素抵抗的发生情况.结果 与C组和V组比较,Ala-Gln组血清INS、TNF-α、FFA的浓度、BG、HOMA-IR降低,ISI升高,胰岛素抵抗发生率降低,术后排气时间及住院时间明显缩短(P＜0.05).C组和V组各指标比较差异无统计学意义(P＞0.05).结论 N(2)-L-丙氨酰-L-谷氨酰胺可有效地减轻结肠癌患者围术期胰岛素抵抗,有助于患者术后恢复,其作用机制可能与谷氨酰胺可降低血液TNF-α及FFA的浓度有关.
目的 評價N(2)-L-丙氨酰-L-穀氨酰胺對結腸癌患者圍術期胰島素牴抗的影響.方法 擇期行結腸癌根治術的非糖尿病患者60例,年齡35～75歲,BMI 18.5～25.0 kg/m2,ASA分級Ⅰ或Ⅱ級,採用隨機數字錶法,將其隨機分為3組(n=20):對照組(C組)于術前24h、術後1h靜脈輸註生理鹽水22.5 ml/kg；載體溶液組(V組)于術前24h、術後1h靜脈輸註複方氨基痠22.5 ml/kg；藥物治療組(Ala-Gln組)于術前24h、術後1h靜脈輸註N(2)-L-丙氨酰-L-穀氨酰胺(含穀氨酰胺0.5 g/kg,溶于複方氨基痠)22.5 ml/kg.于術前24 h(T)、痳醉前30 min(T2)、痳醉給藥後3 h(T3)、術後1 h(T4)和24 h(T5)時空腹條件下採集靜脈血樣,測定血糖(BG)、血清胰島素(INS)、TNF-α、遊離脂肪痠(FFA)的濃度,計算胰島素牴抗指數(HOMA-IR)及胰島索敏感指數(ISI).記錄術後的排氣時間、住院時間及用藥後胰島素牴抗的髮生情況.結果 與C組和V組比較,Ala-Gln組血清INS、TNF-α、FFA的濃度、BG、HOMA-IR降低,ISI升高,胰島素牴抗髮生率降低,術後排氣時間及住院時間明顯縮短(P＜0.05).C組和V組各指標比較差異無統計學意義(P＞0.05).結論 N(2)-L-丙氨酰-L-穀氨酰胺可有效地減輕結腸癌患者圍術期胰島素牴抗,有助于患者術後恢複,其作用機製可能與穀氨酰胺可降低血液TNF-α及FFA的濃度有關.
목적 평개N(2)-L-병안선-L-곡안선알대결장암환자위술기이도소저항적영향.방법 택기행결장암근치술적비당뇨병환자60례,년령35～75세,BMI 18.5～25.0 kg/m2,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기수궤분위3조(n=20):대조조(C조)우술전24h、술후1h정맥수주생리염수22.5 ml/kg；재체용액조(V조)우술전24h、술후1h정맥수주복방안기산22.5 ml/kg；약물치료조(Ala-Gln조)우술전24h、술후1h정맥수주N(2)-L-병안선-L-곡안선알(함곡안선알0.5 g/kg,용우복방안기산)22.5 ml/kg.우술전24 h(T)、마취전30 min(T2)、마취급약후3 h(T3)、술후1 h(T4)화24 h(T5)시공복조건하채집정맥혈양,측정혈당(BG)、혈청이도소(INS)、TNF-α、유리지방산(FFA)적농도,계산이도소저항지수(HOMA-IR)급이도색민감지수(ISI).기록술후적배기시간、주원시간급용약후이도소저항적발생정황.결과 여C조화V조비교,Ala-Gln조혈청INS、TNF-α、FFA적농도、BG、HOMA-IR강저,ISI승고,이도소저항발생솔강저,술후배기시간급주원시간명현축단(P＜0.05).C조화V조각지표비교차이무통계학의의(P＞0.05).결론 N(2)-L-병안선-L-곡안선알가유효지감경결장암환자위술기이도소저항,유조우환자술후회복,기작용궤제가능여곡안선알가강저혈액TNF-α급FFA적농도유관.
Objective To evaluate the effect of N(2)-L-alanyl-L-glutamine (Ala-Glu) on perioperative insulin resistance in patients undergoing radical colon cancer operation.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes aged 35-75 yr with BMI of 18.5-25.0 kg/m2 undergoing redical colon cancer operation under general anesthesia were randomly divided into 3 groups ( n =20 each):control group(group C) ; vehicle group (group Ⅴ) and group Ala-Glu.Ala-Glu 22.5 ml/kg was administered iv at 24 h before and 1 h after operation in group AlaGlu,while in groups C and V equal volume of normal saline and vehicle were given iv instead of Ala-Glu.Venous blood samples were taken at 24 h before operation (T1),30 main before ( T2 ) and 3 h after induction of anesthesia (T3) and 1 and 24 h after operation (T4,T5 ) for determination of blood concentrations of glucose (BG),insulin ( INS)-,TNF-α and free fatty acid (FFA).Insulin resistance ( HOMA-IR =BG × INS ÷ 22.5) and insulin sensitivity index (ISI =1 ÷ (lgBG + lgINS) ) were calculated.The time when the patients passed flatus,the days of hospitali-zation after operation,and the incidence of insulin resistance were recorded.Resuits Ala-Glu significantly decreased blood concentrations of BG,INS,TNF-α,FFA and HOMA-IR and increased ISI in group Ala-Glu as compared with groups C and V.The patients passed flatus earlier after operation and postoperative hospital stay was shorter and the incidence of insulin resistance was lower in group Ala-Glu than in groups C and V.There was no significant difference in all the indexes between group C and group V.Conclusion N (2)-L-alanyl-L-glutamine can attenuate perioperative insulin resistance in patients undergoing colon cancer resection and is helpful to patient' s recovery,and the decrease in the concentrations of TNF-α and FFA may be involved in the mechanism.
