乌司他丁对腹腔镜下直肠癌根治术患者POCD的影响及机制探讨

Effect and mechanism of ulinastatin on POCD of patients undergoing radical resection for rectal cancer under laparoscopic

目的探讨乌司他丁对腹腔镜辅助下行直肠癌根治术的患者术后认知功能障碍(POCD)的影响及其机制。方法收集2011年7月至2014年5月我院行腹腔镜下直肠癌根治术的130例患者的资料,分为观察组(65例,加乌司他丁)和对照组(65例,不加乌司他丁)。比较两组患者的术后认知功能、炎性指标、S100β及血液T淋巴细胞。结果术后观察组患者的POCD发生率低于对照组(P=0.01)。术后3 d,观察组患者的MMSE评分、联想学习及视觉再生评分均高于对照组(P<0.01);观察组患者的CRP、ESR、TNF-α、IL-6、S100β均低于对照组(P<0.01);观察组患者的CD3^+%、CD4^+%、CD4^+/CD8^+均高于对照组(P<0.01),而CD8^+%低于对照组(P<0.01)。结论乌司他丁能够通过抑制炎症反应、改善T细胞免疫功能,降低直肠癌患者POCD发生率。

Objective To discuss the effect of ulinastatin on postoperative cognitive dysfunction of patients undergoing radical resection for rectal cancer under laparoscopic and to investigate the possible mechanism. Methods Clinical data of patients undergoing radical resection for rectal cancer under laparoscopic in our hospital from July 2011 to May 2014 was collected. A total of 130 cases were divided into observation group（ n = 65） and control group（ n =65） according to whether received ulinastatin. The postoperative cognitive function, inflammatory indexes,S100β and blood T lymphocyte of patients in the two groups were compared. Results The incidence of POCD in observation group was lower than that of control group（ P = 0. 01）. Compared with control group, the MMSE score,associative learning and visual regeneration score in observation group were higher（ P〈0. 01） at 3 d after operation, and the levels of CRP,ESR,TNF-α, IL-6 and S100β were lower（ P〈0. 01）; the levels of CD3~＋ %,CD4~＋ %,CD4~＋ /CD8~＋ were higher in the observation group,while the level of CD8~＋ % was lower than the control group（ P〈0. 01）. Conclusion Ulinastatin can reduce the incidence of POCD in patients with rectal cancer by inhibiting the inflammatory reaction and improving the immune function of T cells.