Mahul P, Molliex S, Auboyer C, Levigne F, Jospé R, Dumont A, Gilloz A
Département d'Anesthésie-Réanimation, Hôpital Nord, CHU, Saint-Etienne.
Ann Fr Anesth Reanim. 1993;12(5):512-4. doi: 10.1016/s0750-7658(05)81002-0.
72-year-old patient underwent an elective transurethral resection of the prostate (TURP) performed with a spinal anaesthesia. The irrigation solution contained glycine at a concentration of 15 g.l-1. The patient's level of consciousness deteriorated over the next 4 hours. He went in an areflexic coma with pupillary areflexia and left mydriasis. The diagnosis of TUR syndrome was substantiated by a sodium blood concentration of 98 mmol.l-1, an osmotic gap of 48 mosmol.kg-1 and blood ammonia at 415 mumol.l-1. To investigate the pathophysiological role of glycine and its metabolites, their concentrations were measured by chromatography and spectrometry in plasma and CSF 8, 24 and 48 hours postoperatively. Glycine and its metabolites (serine, alanine, glyoxylic acid and glycolic acid) accumulated during the postoperative period in both blood and CSF. The central nervous system is in direct contact with these neurotropic compounds. Glycine is an inhibitory neurotransmitter, whereas glyoxylic acid and glycolic acid are considered as to be neurotoxic.
一位72岁的患者接受了择期经尿道前列腺切除术（TURP），采用脊髓麻醉。冲洗液中甘氨酸浓度为15 g·l⁻¹。在接下来的4小时内，患者的意识水平恶化。他陷入无反射性昏迷，伴有瞳孔无反射和左侧瞳孔散大。血钠浓度为98 mmol·l⁻¹、渗透压差为48 mosmol·kg⁻¹以及血氨为415 μmol·l⁻¹，证实了TUR综合征的诊断。为了研究甘氨酸及其代谢产物的病理生理作用，在术后8小时、24小时和48小时通过色谱法和光谱法测量了血浆和脑脊液中它们的浓度。术后期间，甘氨酸及其代谢产物（丝氨酸、丙氨酸、乙醛酸和乙醇酸）在血液和脑脊液中均有蓄积。中枢神经系统与这些亲神经化合物直接接触。甘氨酸是一种抑制性神经递质，而乙醛酸和乙醇酸被认为具有神经毒性。
