Tang Gang, Pi Feng, Qiu Yu-Hao, Wei Zheng-Qiang
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Nutr. 2023 Mar 16;10:1040893. doi: 10.3389/fnut.2023.1040893. eCollection 2023.
The clinical utility of glutamine in patients undergoing colorectal cancer (CRC) surgery remains unclear. Therefore, we aimed to investigate the impact of postoperative treatment with glutamine on postoperative outcomes in patients undergoing CRC surgery.
We included patients with CRC undergoing elective surgery between January 2014 and January 2021. Patients were divided into the glutamine and control groups. We retrospectively analyzed postoperative infections complications within 30 days and other outcomes using propensity score matching and performed between-group comparisons.
We included 1,004 patients who underwent CRC surgeries; among them, 660 received parenteral glutamine supplementation. After matching, there were 342 patients in each group. The overall incidence of postoperative complications was 14.9 and 36.8% in the glutamine and control groups, respectively, indicating that glutamine significantly reduced the incidence of postoperative complications [ < 0.001; risk ratio (RR) 0.41 [95% CI 0.30-0.54]]. Compared with the control group, the glutamine group had a significantly lower postoperative infection complications rate (10.5 vs. 28.9%; < 0.001; RR 0.36 [95% CI 0.26-0.52]). Although there was no significant between-group difference in the time to first fluid diet ( = 0.052), the time to first defecation ( < 0.001), first exhaust ( < 0.001), and first solid diet ( < 0.001), as well as hospital stay ( < 0.001) were significantly shorter in the glutamine group than in the control group. Furthermore, glutamine supplementation significantly reduced the incidence of postoperative intestinal obstruction ( = 0.046). Moreover, glutamine supplementation alleviated the decrease in albumin ( < 0.001), total protein ( < 0.001), and prealbumin levels ( < 0.001).
Taken together, postoperative parenteral glutamine supplementation can effectively reduce the incidence of postoperative complications, promote the recovery of intestinal function, and improve albumin levels in patients undergoing CRC surgery.
谷氨酰胺在接受结直肠癌（CRC）手术患者中的临床效用仍不明确。因此，我们旨在研究结直肠癌手术患者术后使用谷氨酰胺治疗对术后结局的影响。
我们纳入了2014年1月至2021年1月期间接受择期手术的结直肠癌患者。患者被分为谷氨酰胺组和对照组。我们使用倾向评分匹配法回顾性分析了30天内的术后感染并发症及其他结局，并进行组间比较。
我们纳入了1004例行结直肠癌手术的患者；其中，660例接受了肠外谷氨酰胺补充。匹配后，每组各有342例患者。谷氨酰胺组和对照组术后并发症的总体发生率分别为14.9%和36.8%，这表明谷氨酰胺显著降低了术后并发症的发生率[P<0.001；风险比（RR）0.41[95%置信区间0.30-0.54]]。与对照组相比，谷氨酰胺组术后感染并发症发生率显著更低（10.5%对28.9%；P<0.001；RR 0.36[95%置信区间0.26-0.52]）。尽管两组在首次流食时间（P=0.052）上无显著组间差异，但谷氨酰胺组的首次排便时间（P<0.001）、首次排气时间（P<0.001）、首次固体食物摄入时间（P<0.001）以及住院时间（P<0.001）均显著短于对照组。此外，补充谷氨酰胺显著降低了术后肠梗阻的发生率（P=0.046）。而且，补充谷氨酰胺缓解了白蛋白（P<0.001）、总蛋白（P<0.001）和前白蛋白水平的下降（P<0.001）。
综上所述，结直肠癌手术患者术后肠外补充谷氨酰胺可有效降低术后并发症的发生率，促进肠道功能恢复，并改善白蛋白水平。
