谷氨酰胺对老年结直肠癌根治术患者术后早期认知功能的影响

Effect of glutamine on the early postoperative cognitive dysfunction of elderly patients undergoing surgery for colorectal cancer

目的探讨谷氨酰胺对老年结直肠癌根治术患者术后早期认知功能的影响。方法选择行结直肠癌根治术的患者66例,按随机数字表法分为谷氨酰胺组(A组)和对照组(C组),每组33例。A组分别于术前24 h、术后1 h静脉滴注谷氨酰胺0.5 g/kg,C组同时点给予等量生理盐水,两组其他麻醉方法相同。记录两组患者术后7 d内围手术期神经认知障碍(PND)的发生率。记录术前3 d、术后1 d(T_(2))、术后7 d(T_(3))实施神经心理学测试[简易智力状态检查(MMSE)、数字符号测试、数字广度-顺向测试、累加测试、循迹连线测试及数字广度-逆向测试]结果,并计算术前3 d和T_(3)时的结果差值。酶联免疫吸附测定法检测两组患者麻醉诱导前(T_(0))、术毕(T_(1))、T_(2)、T_(3)时静脉血血清神经元特异性烯醇化酶(NSE)、白细胞介素(IL)-6、中枢神经特异性蛋白(S100β)浓度。结果C组术后7 d内PND发生率高于A组(P<0.05)。C组T_(2)、T_(3)时循迹连线测试结果低于术前3 d(均P<0.05),T_(3)时数字符号测试、累加测试结果低于术前3 d(均P<0.05);A组数字符号测试、累加测试、循迹连线测试术前3 d与T_(3)时的结果差值小于C组(均P<0.05)。C组T_(1)、T_(2)时血清NSE、S100β浓度高于T(0均P<0.05);A组T_(1)、T_(2)时血清IL-6、NSE、S100β浓度及T_(3)时血清NSE浓度低于C组(均P<0.05)。两组患者其余指标差异无统计学意义(均P>0.05)。结论谷氨酰胺可以有效降低结直肠癌根治术患者术后早期PND的发生率,然而对于远期认知功能的影响还需进一步观察。

Objective To investigate the effect of glutamine on early postoperative cognitive function in elderly patients undergoing radical surgery for colorectal cancer.Methods Sixty-six patients undergoing radical colorectal cancer surgery were divided into a glutamine group(group A)and a control group(group C),according to the random number table method,with 33 patients in each group.Both groups received the same anesthesia methods.While the group A was administered intravenous glutamine 0.5 g/kg 24 h before and 1 h after surgery,the group C received an equivalent amount of normal saline at same time points.The incidence of perioper-ative neurocognitive disorder(PND)within 7 d post-surgery was noted.Neuropsychological tests[Mini-Mental State Examination(MMSE),Digit Symbol Test,Forward Digit Span Test,Serial Addition Test,Trail Making Test,and Backward Digit Span Test]were con-ducted at 3 d preoperatively(T_(1)),1 d postoperatively(T_(2)),7 d postoperatively(T_(3)).The differences between the results obtained 3 d preop-eratively and T_(3)were calculated.Serum concentrations of neuron-specific enolase(NSE),interleukin(IL-6),and S100 calcium-binding proteinβ(S100β)were measured by enzyme-linked immunosorbent assay before anesthesia induction(T_(0)),at T_(1),T_(2),and T_(3).Results The group C has a higher incidence of PND within 7 d post-surgery than group A(P<0.05).In group C,the scores of the Trail Making Test at T_(2)and T_(3)were lower than those at 3 d preoperatively(all P<0.05),and the results of the Digit Symbol Test and Serial Addition Test at T_(3)were lower than those at 3 d preoperatively(all P<0.05).The differences among the 3 d preoperative and T_(3)scores for the Digit Symbol Test,Serial Addition Test,and Trail Making Test in group A were smaller than those in group C(all P<0.05).Serum concentra-tions of NSE and S100βin group C were high at T_(1)and T_(2)compared to the concentration at T_(0)(all P<0.05).In group A,serum concen-trations of IL-6,NSE,and S100βat T_(1)and T_(2),and NSE at T_(3),were lower than those in group C(all P<0.05).There was no significant difference in other indexes between the two groups(all P>0.05).Conclusions Glutamine can effectively reduce the incidence of ear-ly PND in patients undergoing radical colorectal cancer surgery.However,its long-term effects on cognitive function require further ob-servation.