右美托咪定联合乌司他丁对ERAS腹腔镜手术老年患者术后谵妄及NSE、S100β蛋白水平的影响

Effects of dexmedetomidine combined with ulinastatin on postoperative delirium and NSE and S100βprotein levels in elderly patients undergoing laparoscopic surgery within an ERAS protocol

目的探讨右美托咪定联合乌司他丁对加速术后康复(ERAS)腹腔镜胆囊切除术老年患者术后谵妄(POD)及血清神经元特异性烯醇化酶(NSE)、S100β蛋白水平的影响。方法选取2019年9~12月在我院择期行腹腔镜胆囊切除手术的老年患者90例,男43例,女47例,年龄65~75岁,ASA分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为3组:对照组(S组,n=30)、乌司他丁组(U组,n=30)、右美托咪定+乌司他丁组(DU组,n=30)。所有患者均按ERAS流程准备。于麻醉诱导前10 min,U组泵注乌司他丁2 kU/kg,后以1 kU/(kg·h)泵注至术毕;DU组泵注右美托咪定0.5μg/kg和乌司他丁2 kU/kg,后持续泵注右美托咪定0.3μg/(kg·h)和乌司他丁1 kU/(kg·h)至术毕;S组则在相同时点持续泵注等量生理盐水。分别在手术前1 d(T0)、术后1 d(T1)、术后3 d(T2)、术后7 d(T3)采用意识混乱评估法(CAM)进行评估,并统计每组POD的发生情况;于T0、T1、T2时分别采集外周静脉血,用ELISA法检测NSE和S100β蛋白水平。结果T0时各组血清学检测指标差异无统计学意义;与S组比较,T1、T2时U组、DU组NSE、S100β蛋白浓度降低(P<0.05);与U组比较,T1、T2时DU组NSE、S100β蛋白浓度均降低(P<0.05)。在使用CAM评分的各组中DU组仅1例(3.3%)发生POD,明显低于U组的5例(16.7%)和S组的11例(36.7%)(P<0.05)。结论右美托咪定联合乌司他丁可减轻ERAS腹腔镜胆囊切除术老年患者POD的发生,可能与降低血清NSE及S100β蛋白水平相关。

Objective To investigate the effect of dexmedetomidine combined with ulinastatin on postoperative delirium(POD)and neuron-specific enolase(NSE)and S100βprotein levels in elderly patients undergoing laparoscopic cholecystectomy within an enhanced recovery after surgery(ERAS)protocol.Methods A total of 90 elderly patients undergoing elective laparoscopic cholecystectomy,aged 65 to 75 years,ASAⅠorⅡ,from September to December,2019 in our hospital were divided into three groups,the control group(group S,n=30),the ulinastatin group(group U,n=30),(dexmedetomidine+ulinastatin)group(group DU,n=30),by random number table method.All patients received treatments according to the ERAS procedure.The group U was pumped with 2 kU/kg of ulinastatin,10 min before the induction of anesthesia,and then was pumped with l kU/(kg·h)of ulinastatin until the operation was completed.Group DU was pumped with 0.5μg/kg of dexmedetomidine and 2 kU/kg of ulinastatin firstly,and then 0.3μg/(kg·h)of dexmedetomidine and 1 kU/(kg·h)of ulinastatin until the operation was completed.Group S was continuously pumped with equal normal saline.Consciousness assessment method(CAM)was performed at 1 d before surgery(T0),1 d(T1),3 d(T2),and 7 d(T3)after surgery,and the incidence of POD in each group was calculated.Blood was collected from peripheral veins at T1,T2,T3,and serum NSE and S100βlevels were measured by ELISA.Results There was no statistically significant difference in the serological test at T0.Compared with group S,the NSE and S100βconcentrations decreased in group U and group DU at T1 and T2(P<0.05).Compared with group U,the NSE and S100βconcentrations decreased in group DU at the T1 and T2(P<0.05).In each group using the CAM score,there was one case of POD(3.3%)in group DU,which was significantly less than 5 cases(16.7%)in group U and 11 cases(36.7%)in group S(P<0.05).Conclusion Dexmedetomidine combined with ulinastatin can reduce the occurrence of POD in elderly patients undergoing laparoscopic cholecystectomy within an ERAS protocol.It may be associated with reduced serum NSE and S100βprotein levels.