乌司他丁联合右美托咪定对老年患者胸腔镜肺癌根治术术后认知功能的影响  

Effect of ulinastatin combined with dexmedetomidine on postoperative cognitive function in elderly patients undergoing thoracoscope assisted radical lung cancer surgery

作　　者：戴莲青[1] 孙静雪 毕继伟 张研[1] DAI Lian-qing(Department of Anesthesiology,Shenzhen traditional Chinese Medicine Hospital,Shenzhen,Guangdong,518033,China)

机构地区：[1]深圳市中医院麻醉科,广东深圳518033 [2]深圳市人民医院麻醉科,广东深圳518020

出　　处：《齐齐哈尔医学院学报》2020年第13期1633-1636,共4页Journal of Qiqihar Medical University

摘　　要：目的探讨乌司他丁联合右美托咪定对老年患者胸腔镜肺癌根治术术后认知功能的影响。方法选择2017年1月—2020年4月本院收治的90例ASA择期行胸腔镜肺癌根治术的老年患者作为研究对象,按随机数表法分为右美托咪定组(D组)、乌司他丁组(U组)和乌司他丁与右美托咪定联合组(A组),每组各30例。术中D组、U组和A组分别静脉泵注右美托咪定、乌司他丁、乌司他丁和右美托咪定。观察每组术后MMES评分及认知功能障碍发生率,比较三组患者治疗前后血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、血清S-100蛋白(S100β)水平。结果 A组术后MMSE评分明显高于D组和U组(P<0.05)。A组术后认知功能障碍发生率显著低于D组和U组(P<0.05)。A组患者术毕即时、术后1天和术后3天的血清TNF-α、IL-6及S100β水平均明显低于D组和U组(P<0.05),差异均具有统计学意义。结论与单独使用右美托咪定或乌司他丁相比,乌司他丁联合右美托咪定能更有效的减少胸腔镜肺癌根治术后血清TNF-α、IL-6及S100β蛋白含量,降低POCD的发生,其机制可能与减少炎症反应有关。Objective To evaluate the effect of ulinastatin combined with dexmedetomidine on postoperative cognitive function in elderly patients undergoing thoracoscope assisted radical lung cancer surgery.Methods Ninety elderly patients,aged from 65 to 85 years old and of ASA gradeⅠtoⅢ,who underwent thoracoscope-assisted radical lung cancer surgery in our hospital from January 2017 to April 2020 were selected as study subjects and divided into dexmedetomidine group(group D),Ulinastatin group(group U)and Ulinastatin combined with dexmedetomidine group(group A)by the principle of random number table method,with 30 cases in each group.The patients in group D received dexmedetomidine,patients in group U were given intravenous infusion of ulinastatin.In group A,the patients had intravenous injection of ulinastatin and dexmedetomidine.Postoperative MMES scores and the incidence of postoperative cognitive dysfunction were observed.The levels of TNF-α,serum IL-6 and S100βbefore and after operation were measured and compared.Results The MMSE score in group A was higher than that in group D and group U(P<0.05).Compared with the other two groups,the incidence of postoperative cognitive dysfunction(POCD)in group A was significantly lower(P<0.05).Levels of TNF-α,serum IL-6 and S100βin group A at the end of operation,the first and the sixth day after surgery were lower than those in the other two groups(P<0.05),and there were statistically significant differences.Conclusions Compared with use ulinastatin or dexmedetomidine only,ulinastatin combined with dexmedetomidine could decrease the postoperative levels of TNF-α,serum IL-6 and S100βin the elderly patients undergoing thoracoscope-assisted radical lung cancer surgery,reduce the incidence of POCD and its mechanisms may be related to reducing the systemic inflammatory response.

关 键 词：乌司他丁 右美托咪定 术后认知 胸腔镜 肺癌根治术 

分 类 号：R320.21[医药卫生—人体解剖和组织胚胎学]