乌司他丁对老年患者全身麻醉非心脏手术后认知功能障碍影响的Meta分析

Effect of ulinastatin on postoperative cognitive dysfunction in elderly patients after receiving noncardiac surgery under general anesthesia： a Meta analysis

目的系统评价围手术期使用乌司他丁对老年患者全身麻醉非心脏手术后认知功能障碍（postoperative cognitive dysfunction，POCD）的影响。方法计算机检索PubMed、Embase、Coehrane、中国知网、万方数据库、维普网中乌司他丁对老年患者全身麻醉术后认知功能影响的随机对照试验（randomized controlled trials，RCT）。检索时限为自建库至2016年3月。由两位评价员按照纳入与排除标准，独立筛选文献、提取数据资料、评估文献质量后，采用RevMan5．3软件进行Meta分析。结果共纳入lO个RCT，706例患者。Meta分析结果显示：①与对照组比较，围手术期使用乌司他丁能降低老年患者术后第1天[比值比（oddsratio，OR）=0．32，95％CI：0．16～0．62，P〈O．05]、术后第3天（OR=0．28，95％CI：0．14～0．58，P〈O．051和术后第7天（OR=0．25，95％CI：O．14～0．40，P〈O．05）的POCD发生率。②与对照组比较，乌司他丁降低了术后第1天[标准化均数差（standardized mean difference，SMD）=-2．93，95％CI：-4．43～1．44，P〈0．05]和术后第3天（SMD=-1．80，95％CI：-2．91- -0．69，P〈O．05）的IL石水平，以及术后即刻（SMD=-1．75，95％CI：-2．90- -0．61，P〈O．05]和术后第1天（SMD=-2．43，95％CI：-2．91- -1．95，P〈O．05）的S10013蛋白水平。结论围手术期预防性使用乌司他丁可以有效降低非心脏手术老年患者全身麻醉POCD发生率，减轻炎症反应，降低脑细胞的损伤。

Objective Systematically evaluation the effect of ulinastatin on postoperative cognitive dysfunction （POCD） in elderly patients after receiving noncardiac surgery under general anesthesia. Methods The randomized controlled trials （RCT） about influence of Ulinastatin on POCD of elderly patients after receiving noncardiac surgeries with general anesthesia were searched in PubMed, Embase, Cochrane, CNKI, VIP and Wanfang data library till March, 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for Meta analysis. Results A total of 10 RCT were included. The results of Meta analysis showed that： ① compared with the control group, Ulinastatin reduced the incidence of postoperative cognitive dysfunction on the first day [odds ratio （OR）=0.32, 95%CI： 0.16-0.62, P〈0.05）, on the third day （OR=0.28, 95%CI： 0.14-0.58, P〈0.05） and on the seventh day （0R=0.25, 95% CI： 0.14-0.46, P〈0.05）. ② Compared with the control group, Ulinastatin decreased the expression level of inflammatory factor IL-6 [after 24 h： standardized mean difference （SMD）=-2.93, 95%CI： -4.43- -1.44, P〈0.05, after 3 d： SMD=-1.80, 95%CI： -2.91- -0.69, P〈0.05]. Uhnastatin also reduced the expression of S10013 （instant： SMD=-l.75, 95%CI： -2.90- -0.6t, P〈0.05, after 24 h： SMD=-2.43, 95%CI： -2.91- -1.95, P〈0.05）. Conclusions Ulinastatin can effectively reduce the incidence of POCD in elderly patients after receiving noncardiac surgeries under general anesthesia and decreased the expression of inflammatory factor IL-6 and S10013.