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目的：探讨丙氨酰谷氨酰胺对体外循环瓣膜置换术患者肺屏障功能的影响。方法：择期体外循环（cardiopulmonary bypass， CPB）下行心脏瓣膜置换术患者60 例，随机分为3 组，每组20 例，分别为生理盐水组（C 组）、复方氨基酸注射液组（A 组）和 Ala-GLn 组（G 组）。G 组泵注丙氨酰谷氨酰胺0.4 g/（kg·d），A 组和C 组分别泵注等量的复方氨基酸注射液和生理盐水，三组均持续输注24 h。分别于：麻醉后(T0)、开胸后CPB 前（T1）、主动脉开放30 min（T2）、关胸(T3)、术后5 h(T4)、术后24 h(T5)、术后48 h(T6)，经静脉采血3 mL，检测血浆IL-6、TNF-alpha 和SP-A 的含量；采动脉血进行血气分析；观察ICU 机械通气时间。结果：与T0 比较，三组患者在T2、T3、T4、T5时间点的血清TNF-alpha和IL-6 含量均显著升高（P<0.05）；G 组患者血清TNF-琢和IL-6 的浓度显著低于C 组和A 组（P<0.05）；与T0 比较，三组患者在T2~T5各时间点的SP-A 水平显著升高(P<0.05)，G组患者血清SP-A 含量显著低于C 组和A 组（P<0.05）；与T0 比较，三组患者在T2~T5时的RI 值显著升高（P<0.05），G 组患者RI 值显著低于C 组和A 组（P<0.05）；G 组的机械通气时间比C 组和A 组显著缩短（P<0.05）。结论：丙氨酰谷氨酰胺能降低体外循环瓣膜置换术患者的炎症反应，保护肺泡屏障功能，具有一定的肺保护作用。

英文摘要:

Objective:To investigate the effects of alanyl glutamine on alveolar barrier function in patient undergoing valve replacement operation using cardiopulmonary bypass(CPB).Methods:60 patients undergoing valve replacement operation using cardiopulmonary bypass were randomly divided into 3 groups (n=20 each group): alanyl glutamine group(group G), compound amino acid injection group(group A) and normal saline (group C ). In group G, alanyl glutamine 0.4 g/（kg·d）were infused. Group A and group C were respectively infused compound amino acid injection and saline. The infusion time was 24 h. 3 mL venous blood was taken for IL-6, TNF-琢and SP-A detection accompanied by arterial blood gas analysis at time between anesthesia and preoperative (T0), between open chest and CPB (T1), after opening of aorta 30 min（T2）, at the end of operation（T3）, 5 hours after the operation (T4), 24 h after the operation (T5), and 48 h after the operation (T6). The mechanical ventilation time was observed in ICU.Results:Compared with T0, the level of TNF-alpha and IL-6 in the three groups at T2, T3, T4, T5 point were notable raised (P<0.05). Compared with group C and group A, the level of TNF-alpha and IL-6 in group G was significantly lower (P<0.05). Compared with T0, the SP-A level in the three groups was increased at T2 to T5 (P<0.05). The serum SP-A protein concentration in group G was significantly lower than group A and group C (P<0.05). Compared with T0, the RI values in the three group were significant increased at T2～T5 (P<0.05); the RI values in group G were sig- nificant lower than group C and groupA (P<0.05). The time of mechanical ventilation in group G was significant shorter than group C and group A (P<0.05).Conclusion:Alanyl glutamine can decrease the inflammatory response, protect alveolar barrier function, thus protect the lung frominjury.

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