乌司他丁对老年患者直肠癌根治术后认知功能障碍的影响  

Effect of Ulinastatin on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic radical resection of rectal cancer

作　　者：丁登峰[1] 刁文波[1] 黄强[1] 马磊[1] 董心童[1] 张雪萍[1] 

机构地区：[1]暨南大学第二临床医学院附属深圳市人民医院麻醉科,广东深圳518020

出　　处：《中国现代医学杂志》2018年第7期74-78,共5页China Journal of Modern Medicine

基　　金：深圳市科技计划项目(No:JCYJ20140416122812032);深圳市卫生计生系统科研项目(No:201501005)

摘　　要：目的观察乌司他丁对老年患者腹腔镜直肠癌根治术后认知功能障碍(POCD)的影响。方法拟行腹腔镜直肠癌根治术的老年患者60例,随机分为对照组(C组)和实验组(U组),每组30例。U组麻醉诱导前静脉注射乌司他丁20万u,然后以10万u/h的速度持续静脉泵注射至患者离室,C组给予等剂量的生理盐水。测定患者手术前1天(T_0)、手术结束时(T_1)、手术后第1天(T_2)和手术后第3天(T_3)血浆IL-6、TNF-α和S100β的浓度,并在T_0、T_2和T_3时点完成简易精神状态检查量表(MMSE)评分,记录POCD发生率。结果两组T_1时点IL-6、TNF-α和S100β水平高于其他时点(P<0.05),C组T_2时点IL-6和TNF-α水平高于T_0和T_3时点(P<0.05);U组T_1时点IL-6、TNF-α和S100β水平低于C组(P<0.05),T_2时点IL-6和TNF-α水平低于C组(P<0.05)。C组术后T_2时点MMSE评分低于T_0和T_3时点(P<0.05),U组T_2时点MMSE评分高于C组(P<0.05),U组POCD发生率低于C组(P<0.05)。结论乌司他丁可降低腹腔镜直肠癌根治术老年患者术后IL-6、TNF-α和S100β水平,减轻全身炎症反应和中枢神经系统细胞损伤,减少POCD的发生。Objective To observe the influence of Ulinastatin on postoperative cognitive dysfunction （POCD） in the elderly patients undergoing laparoscopic radical resection of rectal cancer. Methods Sixty elderly patients scheduled for laparoscopic radical resection of rectal cancer were randomly allocated to control group and observation group with 30 in each. The patients in the observation group received sustained intravenous injection of 100,000 U/h Ulinastatin after injection of 200,000 U before anesthesia induction. Those in the control group received the same dosages of normal saline. The plasma concentrations of IL-6, TNF-α and S100β were determined 1 day before operation （T0）, at the end of operation （T1）, 1 day （T2） and 3 day （T3） after operation. Postoperative cognitive dysfunction was assessed by Mini-mental State Examination （MMSE） at T0, T2 and T3. Results The levels of IL-6, TNF-α and S100β were the highest at T1 in both groups （P 〈 0.05）. In the control group, the levels of IL-6 and TNF-α at T2 were higher than those at T0 and T3 （P 〈 0.05）. The levels of IL-6, TNF-α and S100β were signifcantly lower in the observation group than in the control group at T1 （P 〈 0.05）. Compared with the control group, the levels of IL-6 and TNF-α were lower and MMSE scores were higher in the observation group at T2 （P 〈 0.05）. In addition, MMSE scores at T2 were lower than those at T0 and T3 in the control group （P 〈 0.05）. Finally, the incidence of POCD was lower in the observation group （P 〈 0.05）. Conclusions Ulinastatin can decrease the plasma concentrations of IL-6, TNF-α and S100β and reduce the risk of POCD in the elderly patients undergoing laparoscopic radical resection of rectal cancer.

关 键 词：乌司他丁 老年人 直肠癌根治术 术后认知功能障碍 

分 类 号：R614.2[医药卫生—麻醉学]