Department of Anaesthesiology and Intensive Care Medicine, Pain Therapy, University Hospital Giessen and Marburg GmbH, Giessen, Germany.
Acta Anaesthesiol Scand. 2009 Nov;53(10):1317-23. doi: 10.1111/j.1399-6576.2009.02084.x. Epub 2009 Aug 12.
Cardiac surgery with an extracorporeal circulation cardiopulmonary bypass (CPB) is characterized by an oxidative stress response. Glutathione (GSH) belongs to the major antioxidative defense. In metabolic stress, glutamine (GLN) may be the rate-limiting factor of GSH synthesis. Decreased GLN plasma levels were observed after various critical states. We evaluated, in patients undergoing open heart surgery with CPB, the effects of a peri-operative GLN supplementation on GSH in whole blood and assessed their influence on the Sequential Organ Failure Assessment score and the intensive care unit length of stay.
In this prospective, randomized, double-blinded study, we included 60 patients (age older than 70 years, ejection fraction <40% or mitral valve replacement) undergoing an elective cardiac surgery with CPB. We randomly assigned each subject to receive an infusion with either GLN (0.5 g/kg/day, group 1) or an isonitrogeneous, isocaloric, isovolemic amino acids solution (group 2) or saline (group 3).
From the first post-operative day GLN plasma levels in group 1 were significantly increased compared with the other groups. With saline GSH the levels decreased significantly post-operatively compared with GLN. We observed a significant correlation between GLN delivery and GSH levels.
A peri-operative high-dose GLN infusion increased plasma GLN concentrations and maintained the GSH levels after cardiac surgery with CPB.
体外循环心肺转流（CPB）心脏手术的特点是氧化应激反应。谷胱甘肽（GSH）属于主要抗氧化防御系统。在代谢应激中，谷氨酰胺（GLN）可能是 GSH 合成的限速因素。在各种危急状态后，观察到 GLN 血浆水平降低。我们评估了接受 CPB 体外循环心脏手术的患者围手术期 GLN 补充对全血 GSH 的影响，并评估其对序贯器官衰竭评估评分和重症监护病房住院时间的影响。
在这项前瞻性、随机、双盲研究中，我们纳入了 60 名（年龄大于 70 岁，射血分数<40%或二尖瓣置换术）接受 CPB 择期心脏手术的患者。我们将每个患者随机分配到接受 GLN（0.5 g/kg/天，组 1）或等氮、等热量、等容量氨基酸溶液（组 2）或生理盐水（组 3）输注。
从术后第一天开始，组 1 的 GLN 血浆水平明显高于其他组。与 GLN 相比，组 3 的 GSH 水平在术后明显下降。我们观察到 GLN 给药与 GSH 水平之间存在显著相关性。
围手术期高剂量 GLN 输注可增加 CPB 心脏手术后的血浆 GLN 浓度并维持 GSH 水平。
