【作者】 王毅；

【导师】 张赛； 焦德让； 翟宝进；

【作者基本信息】 天津医科大学 ， 外科学， 2010， 硕士

【摘要】 目的：实验拟观察经皮血管成形支架置入前静脉应用乙酰谷酰胺注射液对患者血浆中兴奋性氨基酸浓度变化的影响。方法：选择2005-01／2006-06武警医学院附属医院采用经皮血管成形支架置入治疗的颅内或颈部动脉狭窄患者32例,平均64.5岁。狭窄段长度8-18 mm,平均(12.2±4.5)mm。将患者随机分为治疗组16例及对照组16例,对照组采用常规治疗,治疗组入院后静脉点滴乙酰谷酰胺注射液20 mL±生理盐水250 mL,1次／d,7 d。入院时、术前及术后30 min内采血高效液相色谱分析检测血浆谷氨酸及天冬氨酸含量。结果：①术后数字减影血管造影显示两组的狭窄率均下降(P<0.01)。②术前治疗组和对照组的谷氨酸及天冬氨酸含量均低于入院时,治疗组低于对照组(P<0.05)；术后治疗组的谷氨酸及天冬氨酸含量低于对照组(P<0.01)。③32例患者均在狭窄段成功置入支架,技术成功率为96.86%。6个月后,随访复查经颅多普勒超声,大部分病例(28／32,87.50%)狭窄段血流速度下降；对照组中3例(3／32,2.74%)血流速度较术后增加,虽未经血管造影证实,但考虑有再狭窄发生。结论：经皮血管成形支架置入前采用乙酰谷酰胺注射液静脉点滴能够减少血浆兴奋性氨基酸含量,从而降低支架置入后再灌注损伤的风险。更多还原

【Abstract】 AIM:The study investigated the effect of aceglutamide on concentration of excitatory amino acids in plasma of patients before percutaneous transluminal angioplasty stent insertion.METHODS:①Thirty-two patients (averagely 64.5 years) with intracal or cervical arterial stenosis treated by percutaneous transluminal angioplasty and inserting bracket were selected from January 2005 to June 2006 at Hospital Affiliated to Medical College of Chinese People’s Armed Police Forces.8-18 mm stenosis, averagely (12.2±4.5) mm.②Patients were randomly divided into the control group (n =16) and the therapy group (n=16). Patients in the control group received conventional therapy, whereas those in the therapy group received aceglutamide (20 mL) plus saline (250 mL), once a day, for 7 days. Levels of plasma aminoglutaminic acid and aminosuccinic acid were detected at admission,30 minutes before and after surgery by high performance liquid chromatogram.RESULTS:①Stenosis rate was decreased in both groups by digital subtraction angiography (DSA) after surgery (P< 0.01).②Before operation, contents of plasma aminoglutaminic acid and aminosuccinic acid were decreased in both groups, and the content of the therapy group was lower than the control group (P< 0.05). After surgery, the content of control group was higher than in the therapy group (P< 0.01).③Stents were successfully implanted in 32 patients with the success rate of 96.86%. Six months later, blood flow velocity was reduced in stenosis segment in most cases (28/32,87.50%) by transcranial Doppler sonography. Blood flow velocity was increased in three cases (3/32,2.74%) of the control group, which was not treated by angiography.CONCLUSION:The treatment of aceglutamide via i.v. before percutaneous transluminal angioplasty stent insertion can decrease the content of plasma aminoglutaminic acid, resulting in the risk of reperfusion injury after surgery.更多还原