胰岛素鼻内给药对老年腹腔镜结直肠癌根治术患者术后神经认知功能的影响  

Effect of intranasal insulin administration on postoperative neurocognitive disorders in patients undergoing laparoscopic radical surgery for colorectal cancer

作　　者：张海龙[1] 李民[1] 李若凡[2] 吴迪[1] 赵丽琴 ZHANG Hailong;LI Min;LI Ruofan;WU Di;ZHAO Liqin(Department of Anesthesiology,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China;Department of Gastrointestinal Surgery,Beijing Luhe Hospital Affiliated to Capital Medical University,Beijing 101149;Department of Anesthesiology,Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京潞河医院麻醉科,北京101149 [2]首都医科大学附属北京潞河医院胃肠外科,北京101149 [3]首都医科大学附属北京地坛医院麻醉科,北京100015

出　　处：《大连医科大学学报》2024年第5期410-415,421,共7页Journal of Dalian Medical University

摘　　要：目的评价胰岛素鼻内给药对老年腹腔镜结直肠癌根治术患者术后神经认知功能的影响。方法收集2023年8月至11月于首都医科大学附属北京潞河医院择期行全麻下腹腔镜结直肠癌根治术的老年患者64例,其中男44例,女20例,年龄≥65岁,BMI≤25 kg/m^(2),ASA分级Ⅰ~Ⅲ级,采用随机数字表法分为胰岛素组(I组)和对照组(C组),每组32例。术前2天开始使用鼻腔喷雾装置鼻内给药,I组给予胰岛素20 U(0.5 mL)/次,C组给予生理盐水0.5 mL/次,两组均鼻内给药2次/d,至手术当日。所有患者均行全凭静脉麻醉。于鼻腔给药前和术后7天采用简易智力状态检查量表(MMSE)进行认知功能测验,观察术后认知功能障碍(POCD)的发生情况。于入室时(T_(0))、术毕即刻(T_(1))、术后1天(T_(2))、术后3天(T_(3))、术后5天(T_(4))测定血清白细胞介素6(IL-6)、肿瘤坏死因子(TNF-α)、S100β浓度,于T_(0)、T_(1)时测定血糖浓度,观察鼻腔给药后两组患者胰岛素过敏反应、鼻腔刺激反应及低血糖反应发生情况。结果最终61例完成本研究,其中I组30例,C组31例。两组患者年龄、性别比、BMI、ASA分级、TNM分期、受教育年限、手术时间、术中丙泊酚、瑞芬太尼用量及术中出血比较,差异均无统计学意义(P>0.05)。与C组比较,I组术后7天MMSE评分升高,POCD发生率降低,T_(1~4)时血清IL-6、TNF-α、S100β浓度水平降低,差异有统计学意义(P<0.05)。两组T_(0)、T_(1)时血糖浓度比较,差异无统计学意义(P>0.05)。两组均未发生胰岛素过敏反应、鼻腔刺激反应及低血糖反应。结论老年腹腔镜结直肠癌根治术患者术前胰岛素鼻内给药可减轻全身炎症反应及脑损伤,降低POCD发生率。Objective To evaluate the effect of intranasal insulin administration on postoperative neurocognitive disorders in elderly patients undergoing laparoscopic radical surgery for colorectal cancer.Methods A total of 64 elderly patients(44 males and 20 females,age≥65 years,with BMI≤25 kg/m^(2) and ASA gradeⅠ-Ⅲ),who underwent laparoscopic radical surgery for colorectal cancer under general intravenous anesthesia at Beijing Luhe Hospital Affiliated to Capital Medical University from September 2022 to March 2023,were enrolled in the study.The patients were randomly divided into two groups,insulin group(group I)and control group(group C),with 32 patients in each group.A nasal spray device was used for intranasal administration two days before surgery.Group I received 20 U(0.5 mL)of insulin per dose,while group C received 0.5 mL of normal saline.Both groups received intranasal administration twice daily until the day of surgery.All patients underwent total intravenous anesthesia.Mini Mental State Examination(MMSE)was used for evaluation of cognitive function before intranasal administration and 7 days post-surgery,and postoperative cognitive dysfunction(POCD)incidence was observed.Venous blood was drawn at admission(T_(0)),immediately after surgery(T_(1)),and on postoperative day 1(T_(2)),day 3(T_(3))and day 5(T_(4))to determine serum concentrations of interleukin-6(IL-6),tumor necrosis factor(TNF-α),and S100β.Blood glucose levels were measured at T_(0)and T_(1).The occurrence of insulin allergy,nasal irritation and hypoglycemia was observed after intranasal administration in both groups.Results A total of 61 patients completed the study,including 30 in group I and 31 in group C.There were no statistically significant differences between the two groups of patients in terms of age,gender ratio,body mass index,ASA grade,TNM stage,years of education,operation time,intraoperative propofol and remifentanil dosage,and intraoperative blood loss(P>0.05).Compared with group C,group I showed higher MMSE scores and lower i

关 键 词：胰岛素 鼻内 结直肠癌根治术 老年 认知功能障碍 

分 类 号：R614.2[医药卫生—麻醉学]