目的 探究术前口服姜黄素胶囊对行胃肠道肿瘤根治术的老年患者术后谵妄(POD)的影响，并初步探讨姜黄素作用于POD的炎性机制。方法 选取2024年3-7月于某医院全身麻醉下行腹腔镜胃肠道肿瘤根治术的老年患者70例为研究对象，按照随机数字表法分为对照组和姜黄素组，每组35例。术前2 d对照组和姜黄素组患者分别给予安慰剂(与姜黄素组相同材质空胶囊)和姜黄素胶囊500 mg，两组均口服1次/d，至手术当天麻醉前服用最后一次，共3次。入组前使用简易智力状态检查量表(MMSE)对患者认知功能进行评定，于术后第1天(T2)、第2天(T3)、第3天(T4)采用ICU意识模糊评估量表(CAM-ICU)和视觉模拟评分法(VAS)分别对患者POD的发生情况及疼痛程度进行评估。于干预前(T0)、术毕(T1)、T2、T4时点分别收集患者静脉血3 mL，采用酶联免疫吸附测定法测定血清中白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)和单核细胞趋化蛋白-1(MCP-1)水平。记录两组患者术后恶心、呕吐发生率。结果 与对照组比较，姜黄素组术后T2、T4时点POD发生率，T2和T4时点IL-1β和IL-6水平，T1、T2和T4时点TNF-α，T1时点CRP水平均降低(P＜0。05);两组患者T1、T2、T4时点IL-1β、IL-6、TNF-α、CRP和MCP-1水平均高于T0(P＜0。05)。两组患者术后VAS评分及恶心、呕吐发生率比较，差异均无统计学意义(P＞0。05)。结论 老年患者术前预先服用姜黄素胶囊可降低术后3 d POD总发生率及炎性因子IL-1β、IL-6、TNF-α、CRP水平，且不会增加恶心、呕吐不良反应发生率。
Effect of Curcumin on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Gastrointestinal Tumors
Objective To explore the effect of preoperative oral administration of curcumin capsules on postoperative delirium(POD)in elderly patients undergoing radical resection of gastrointestinal tumors,and to explore its inflammatory mechanism.Methods A total of 70 elderly patients who underwent laparoscopic radical resection of gastrointestinal tumors under general anesthesia in a hospital from March 2024 to July 2024 were selected as the study subjects.They were divided into the control group and the curcumin group by random number table method,with 35 cases in each group.On the second day prior to the surgery,patients in the control group orally took placebo(an empty capsule made of the same material as the capsule taken by the control group,and patients in the curcumin group orally took 500 mg of curcumin capsules.Both groups were given one dose per day until the last dose before anesthesia on the day of surgery,for a total of three times.The Mini-mental State Examination(MMSE)scale was utilized for assessing patients'cognitive function before enrollment.Confusion Assessment Method of the Intensive Care Unit(CAM-ICU)scale and Visual Analogue Scale(VAS)were used to evaluate POD occurrence and pain degree on postoperative days 1(T2),2(T3),and 3(T4),respectively.Three mL of venous blood was collected at four time points:before the first intervention(T0),at the end of the operation(T1),T2,and T4.Serum levels of interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),and monocyte chemoattractant protein-1(MCP-1)were determined using enzyme-linked immunosorbent assay(ELISA).The incidence of postoperative adverse reactions such as nausea and vomiting in both groups were recorded.Results Compared to the control group,the curcumin group showed decreased incidence of POD at T2 and T4,decreased IL-1β and IL-6 levels at T2 and T4,decreased TNF-α level at T1,T2 and T4,and decreased CRP level at T1(P＜0.05).The levels of IL-1β,IL-6,TNF-α,CRP and MCP-1 at T1,T2 and T4 were higher than those at T0 in both groups(P＜0.05).There was no significant difference in postoperative VAS score and incidence of nausea and vomiting between the two groups(P＞0.05).Conclusion Preoperative oral administration of curcumin capsules can reduce the total incidence of POD within 3 d after operation and serum levels of IL-1β,IL-6,TNF-α and CRP without increasing the incidence of adverse reactions such as nausea and vomiting in elderly patients undergoing radical resection of gastrointestinal tumors.
万方数据
维普
