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

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（T0）、手术结束时（T1）、手术后第1 天（T2）和手术后第3 天（T3）血浆IL-6、TNF-α 和S100β 的浓度，并在T0、T2 和T3 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T1 时点IL-6、TNF-α 和S100β 水平高于其他时点（P <0.05），C 组T2 时点IL-6 和TNF-α 水平高于T0 和T3 时点（P <0.05）；U 组T1 时点IL-6、TNF-α 和S100β 水平低于C组（P <0.05），T2 时点IL-6 和TNF-α 水平低于C 组（P <0.05）。C 组术后T2 时点MMSE 评分低于T0 和T3 时点（P <0.05），U 组T2 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。

Abstract:

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 significantly 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.