Clinical Study Of N (2)-L-Alanyl-L-Glutamine Lung Protection In Cardiopulmonary Bypass Valve Replacement

Background: With the development of medical technology, cardiopulmonarybypass （CPB） evocable Complications decreased significantly, Because CPBtechnology still has many limitations. After this kind of non physiological cycle,thepatients showed a series of complications, visceral organ correlation injure in CPB, themost common injured organ is lung, although about0.4ï¼…¹.7ï¼…patients show ARDS,but case fatality rate is50ï¼…⁷0％。Therefore, lung protection in cardiopulmonarybypass is still an important topic of current research.Objective: Discuss N （2）-L-alanyl-L-glutamine lung protective effect incardiopulmonary bypass valve replacement, To provide a new direction for the choiceof drugs of lung protection during operation in CPB.Method:60patients with cardiopulmonary bypass valve replacement were chosenin this study, divide into N （2）-L-alanyl-L-glutamine group（G group）, compound aminoacid injection group（A group） and normal saline （C group） at random, each groupwith20patients. G group intravenous infusion of N （2）-L-alanyl-L-glutamine andcompound amino acid miscible liquids（the ratio of1:5）10ml·kg^-1·d^-1, thereintoAla-GLN0.4g·kg^-1·d^-1, control group C group give equal volume of physiologicalsaline, control group A group give equal volume of compound amino acid. Respectivelycarry out arterial blood gas analysis in time between anesthesia and preoperative（T0）,between open chest and CPB （T1）, after opening of aorta30min（T2）, at the end ofoperation（T3）,5hours after the operation （T4）,24h after the operation （T5）, and48hafter the operation （T6） total seven timing, record A-aDO2、RIï¼›Venous blood serumseparation, Application of enzyme-linked immunosorbent assay （ELISA）, detection ofserum interleukin-6（IL-6）, Tumor necrosis factor alpha, the concentration ofsuperoxide dismutase （SOD） and expression level of pulmonary alveoli surface activityproteins A（SP-A）. The mean±standard deviation （±s） express experimental data, apply SPSS13.0software proceed statistical analysis.comparison between intra-classand interblock use one-way analysis of variance, If P<0.05, the difference has markedsignificance.Result: There were no statistically significant differences in age, gender, weight,valve replacement types, CPB time, aortic clamping time between the threegroups（P>0.05）; The content of TNF-α and IL-6in the three groups at the T2, T3, T4, T5point were notable rised compared with T0（P<0.05）; The content of TNF-α and IL-6inthe group G, compared with group C and group A was significantly lower （P<0.05）;Compared with T0, the SOD level in the other three groups at T1, T2, T3, T4, T5, T6timepoint were significant reduced （P<0.05）; the serum SOD concentration in group Gcompared with group C and group A was significant high （P<0.05）; Compared with T0,the SP-A level in the three groups increased at T2to T5（P<0.05）; the serum SP-Aprotein concentration in group G was significantly lower than group A and group C（P<0.05）; Compared with T0, the A-aDO2and RI values in the three group weresignificant increased at T2-T5（P<0.05）; the A-aDO2and RI values in group G weresignificant lower than group C and group A （P<0.05）; the patients with mechanicalventilation in group G was significant lower than group C and group A （P<0.05）.Conclusion: N （2）-L-alanyl-L-glutamine injection by inhibiting the inflammatory response and reduce oxidative stress, so that can reduce Lunginjury in cardiopulmonary bypass.