Lomivorotov Vladimir V, Efremov Sergey M, Shmirev Vladimir A, Ponomarev Dmitry N, Lomivorotov Vladimir N, Karaskov Alexander M
Department of Anaesthesiology and Intensive Care, Academician E. N. Meshalkin Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Heart Surg Forum. 2011 Dec;14(6):E384-8. doi: 10.1532/HSF98.20111074.
The aim of the present study was to investigate the cardioprotective effects of the perioperative use of N(2)-L-alanyl-L-glutamine (GLN) in patients with ischemic heart disease (IHD) who undergo their operations under cardiopulmonary bypass (CPB).
This double-blind, placebo-controlled, randomized study included 50 patients who underwent cardiac surgery with CPB. Exclusion criteria were a left ventricular ejection fraction <50%, diabetes mellitus, <3 months since the onset of myocardial infarction, and emergency surgery. Patients in the study group (n = 25) received 0.4 g/kg GLN (Dipeptiven, 20% solution) per day. Patients in the control group (n = 25) were administered a placebo (0.9% NaCl). The primary end point was the dynamics of troponin I at the following stages: (1) prior to anesthesia, (2) 30 minutes after CPB, (3) 6 hours after CPB, (4) 24 hours after surgery, and (5) 48 hours after surgery. Secondary end points included measurements of hemodynamics with a Swan-Ganz catheter.
On the first postoperative day after the surgery, the median troponin I level was significantly lower in the study group than in the placebo group: 1.280 ng/mL (interquartile range [IQR], 0.840-2.230 ng/mL) versus 2.410 ng/mL (IQR, 1.060-6.600 ng/mL) (P = .035). At 4 hours after cardiopulmonary bypass (CPB), the median cardiac index was higher in the patients in the study group: 2.58 L/min per m2 (IQR, 2.34-2.91 L/min per m2) versus 2.03 L/min per m2 (IQR, 1.76-2.32 L/min per m2) (P = .002). The median stroke index also was higher in the patients who received GLN: 32.8 mL/m2 (IQR, 27.8-36.0 mL/m2) versus 26.1 mL/m2 (IQR, 22.6-31.8 mL/m2) (P = .023). The median systemic vascular resistance index was significantly lower in the study group than in the placebo group: 1942 dyn·s/cm5 per m2 (IQR, 1828-2209 dyn·s/cm5 per m2) versus 2456 dyn·s/cm5 per m2 (IQR, 2400-3265 dyn·s/cm5 per m2) (P = .001).
Perioperative administration of GLN during the first 24 hours has cardioprotective effects in IHD patients following CPB. This technique enhances the troponin concentration at 24 hours after surgery and is associated with improved myocardial function.
本研究旨在探讨围手术期使用N(2)-L-丙氨酰-L-谷氨酰胺（GLN）对接受体外循环（CPB）手术的缺血性心脏病（IHD）患者的心脏保护作用。
这项双盲、安慰剂对照、随机研究纳入了50例接受CPB心脏手术的患者。排除标准为左心室射血分数<50%、糖尿病、心肌梗死发病后<3个月以及急诊手术。研究组（n = 25）患者每天接受0.4 g/kg GLN（Dipeptiven，20%溶液）。对照组（n = 25）患者给予安慰剂（0.9%氯化钠）。主要终点是肌钙蛋白I在以下阶段的动态变化：（1）麻醉前，（2）CPB后30分钟，（3）CPB后6小时，（4）术后24小时，（5）术后48小时。次要终点包括使用Swan-Ganz导管测量血流动力学。
术后第一天，研究组肌钙蛋白I水平中位数显著低于安慰剂组：1.280 ng/mL（四分位间距[IQR]，0.840 - 2.230 ng/mL）对2.410 ng/mL（IQR，1.060 - 6.600 ng/mL）（P = 0.035）。在体外循环（CPB）后4小时，研究组患者心脏指数中位数较高：2.58 L/min per m2（IQR，2.34 - 2.91 L/min per m2）对2.03 L/min per m2（IQR，1.76 - 2.32 L/min per m2）（P = 0.002）。接受GLN的患者每搏量指数中位数也较高：32.8 mL/m2（IQR，27.8 - 36.0 mL/m2）对26.1 mL/m2（IQR，22.6 - 31.8 mL/m2）（P = 0.023）。研究组全身血管阻力指数中位数显著低于安慰剂组：1942 dyn·s/cm5 per m2（IQR，1828 - 2209 dyn·s/cm5 per m2）对2456 dyn·s/cm5 per m2（IQR，2400 - 3265 dyn·s/cm5 per m2）（P = 0.001）。
围手术期在最初24小时内给予GLN对CPB后的IHD患者具有心脏保护作用。该技术可提高术后24小时肌钙蛋白浓度，并改善心肌功能。
