Lomivorotov V V, Efremov S M, Shmyrev V A, Ponomarev D N, Sviatchenko A V, Kniaz'kova L G
Anesteziol Reanimatol. 2012 Mar-Apr(2):14-8.
It was conducted a study of glutamine cardioptotective effects during perioperative use in patients with ischemic heart disease, operated under CB. Exclusion criteria were: left ventricular ejection fraction less than 50%, diabetes melitus, myocardial infarction less than 3 months ago, Patients of the study group (n=25) had glutamine (20% solution N(2)-L-alanine-L-glutamine ("Dipeptiven" Fresenius Kabi, Germany); 0.4 g/kg/day. Patients of control group (n=25) received placebo (0.9% NaCl solution). The main indicators were the dynamics of troponin I, as well as central hemodynamics parameters. On the 1-st day after operation the concentration of troponin I was significantly lower in the glutamine-group compared placebo-group (1.280 (0.840-2.230) 2.410 (1.060-6.600) ng/ml; p=0.035). 4 hours after CB in a glutamine-group also had significantly large indicators of cardiac index (2.58 (2.34-2.91) l/min/m2 vs 2.03 (1.76-2.32)) l/min/m2; p=0,002) and stroke index (32.8 (27.8-36.0.) ml/m2 vs 26.1 (22.6-31.8) ml/m2; p=0.023). Systemic vascular resistance index was significantly lower in glutamine-group (1942 (1828-2209) dyn x s/cm(-5)/m2 vs 2456 (2400-3265) dyn x s/cm(-5)/m2; p=0.001). Conclusion. Perioperative use of N(2)-L-alanine-L-glutamine during the first 24 hours ofperioperative period gives cardioprotective effect in patients with ischemic heart disease operated under CB.
对患有缺血性心脏病且在体外循环（CB）下接受手术的患者围手术期使用谷氨酰胺的心脏保护作用进行了一项研究。排除标准为：左心室射血分数低于50%、糖尿病、3个月内有心肌梗死。研究组患者（n = 25）使用谷氨酰胺（20%的N(2)-L-丙氨酸-L-谷氨酰胺溶液（“Dipeptiven”，德国费森尤斯卡比公司）；0.4 g/kg/天）。对照组患者（n = 25）接受安慰剂（0.9%氯化钠溶液）。主要指标为肌钙蛋白I的动态变化以及中心血流动力学参数。术后第1天，谷氨酰胺组肌钙蛋白I浓度显著低于安慰剂组（1.280（0.840 - 2.230）对2.410（1.060 - 6.600）ng/ml；p = 0.035）。体外循环后4小时，谷氨酰胺组的心脏指数指标也显著更高（2.58（2.34 - 2.91）l/min/m2对2.03（1.76 - 2.32）l/min/m2；p = 0.002）以及每搏输出指数（32.8（27.8 - 36.0）ml/m2对26.1（22.6 - 31.8）ml/m2；p = 0.023）。谷氨酰胺组的全身血管阻力指数显著更低（1942（1828 - 2209）dyn×s/cm(-5)/m2对2456（2400 - 3265）dyn×s/cm(-5)/m2；p = 0.001）。结论。围手术期最初24小时使用N(2)-L-丙氨酸-L-谷氨酰胺对在体外循环下接受手术的缺血性心脏病患者具有心脏保护作用。
