乌司他丁对老年腹腔镜子宫全切术患者术后认知功能的影响

Effect of Ulinastatin on Postoperative Cognition in the Elderly Patients After Laparoscopic Total Hysterectomy

目的探讨乌司他丁(Uli)对老年腹腔镜子宫全切手术后患者认知功能的影响。方法选择美国麻醉师协会(ASA)Ⅰ或Ⅱ级择期行腹腔镜子宫全切手术的老年患者50例,随机分为观察组和对照组。观察组在常规全麻诱导前静滴乌司他丁,接着持续静脉泵注乌司他丁直至手术结束,对照组给予相应生理盐水。于手术前1天(D0)和手术后1(D1)、3(D2)、7(D3)天测定血清白介素-1(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)、神经元特异性烯醇化酶(NSE)、S100β蛋白的含量,并记录简易智力状态检查量表(MMSE)评分,D0和D3测定脑事件相关电位p300潜伏期和振幅,观察术后认知功能下降发生率。结果与D0时间点相比,两组患者在D1时间点均出现MMSE评分的下降[观察组:(24.46±1.69)分比(27.67±2.64)分,对照组:(21.21±1.80)分比(27.19±2.88)分,P<0.05]。炎症因子增高IL-1β[观察组:(16.29±4.61)pg/mL比(10.33±2.99)pg/mL,对照组:(19.58±5.69)pg/mL比(10.45±3.12)pg/mL,P<0.05]、IL-6[观察组:(26.68±3.53)pg/mL比(3.74±0.58)pg/mL,对照组:(42.55±4.36)pg/mL比(3.96±0.63)pg/mL,P<0.05]、TNF-a[观察组:(61.30±11.91)pg/mL比(30.84±3.98)pg/mL,对照组:(80.98±15.33)pg/mL比(30.24±4.05)pg/mL,P<0.05],NSE增高[观察组:(5.35±1.69)μg/mL比(2.78±2.36)μg/mL,对照组:(7.87±3.38)μg/mL比(2.89±1.97)μg/mL,P<0.05],S100β蛋白表达水平增高[观察组:(0.17±0.13)μg/mL比(0.04±0.01)μg/mL,对照组:(0.22±0.33)μg/mL比(0.04±0.01)μg/mL,P<0.05];与对照组相比,观察组在D3时间点MMSE评分增高[(27.54±2.37)分比(25.01±2.12)分,P<0.05];与对照组相比,观察组在D3时间点IL-1β、IL-6、TNFa、NSE、S100β蛋白表达水平降低[(10.22±3.20)pg/mL比(13.33±3.58)pg/mL]、[(3.94±0.69)pg/mL比(14.23±0.84)pg/mL]、[(32.52±5.60)pg/mL比(43.07±4.38)pg/mL]、[(2.34±1.10)μg/mL比(5.65±0.89)μg/mL]、[(0.05±0.01)μg/mL比(0.16±0.0)μg/mL],P均<0.05;与对照组相比,观察组D3时p300潜伏期缩短[(302.34±29.12)比(353.67±35.65),P<0.05],振幅升高[(8.11±2.23)比(5.23±1.93),P<0.05],观察组术后认知功能下降发生率低于对照组(P<0.05)。结论乌司他丁可减轻或预防老年腹腔镜子宫全切手术患者术后认知功能下降,具有脑保护作用。

Objective To evaluate the effect of ulinastatin on post-operative cognition in the elderly patients after laparoscopic total hysterectomy.Methods A total of fifty elderly patients(American society of Anesthesiologists ASAⅠ-orⅡlevel)scheduled for laparoscopic total hysterectomy were randomly divided into 2 groups:ulinastatin group(group U)and control group(group C).Patients in group U were given a loading dosage of ulinastatin intravenously before the induction of general anesthesia,followed by a continuous infusion ofulinastatin till the end of surgery.Patiens in group C were given the equal volume of normal saline.Blood samples were obtained for determination of the plasma concentration of interleukin-1 beta(IL-1β),interleukin-6(IL-6),TNF-α,neuron-specific enolase(NSE),S100βprotein at 1 day before surgery(D0),and 1(D1),3(D2),7(D3)days after surgery.The score of Mini-Mental State Examination(MMSE)was recorded at the same time.P300event-related potential latency and amplitude were determined at D0 and D3,to observe the incidence of postoperative cognition.Results Compared with D0,the scores of MMSE decreased[group U:(24.46±1.69)VS(27.67±2.64),group C:(21.21±1.80)VS(27.19±2.88),P<0.05],and the levels of IL-1β[group U:(16.29±4.61)pg/mL VS(10.33±2.99)pg/mL,group C:(19.58±5.69)pg/mL VS(10.45±3.12)pg/mL,P<0.05],IL-6[group U:(26.68±3.53)pg/mL VS(3.74±0.58)pg/mL,group C:(42.55±4.36)pg/mL VS(3.96±0.63)pg/mL,P<0.05],TNF-α[group U:(61.30±11.91)pg/mL VS(30.84±3.98)pg/mL,group C:(80.98±15.33)pg/mL VS(30.24±4.05)pg/mL,P<0.05],NSE[group U:(5.35±1.69)pg/mL VS(2.78±2.36)pg/mL,group C:(7.87±3.38)pg/mL VS(2.89±1.97)pg/mL,P<0.05],S100βprotein[group U:(0.17±0.13)pg/mL VS(0.04±0.01)pg/mL,group C:(0.22±0.33)pg/mL VS(0.04±0.01)pg/mL,P<0.05]increased in both two groups at D1.Compared with group C,the scores of MMSE significantly elevated[(27.54±2.37)VS(25.01±2.12),P<0.05]and the serum concentrations of IL-1β,IL-6,TNF-α,NSE,S100βprotein significantly reduced[(10.22±3.12)pg/mL VS(13.33±3.58)pg/mL],[(3.94±0.69)pg/mL VS(14.23±0.84)pg/mL],[(32.52±5.60)pg/mL VS(43.07±4.38)pg/mL],[(2.34±1.10)pg/mL VS(5.65±0.89)pg/mL],[(0.05±0.01)pg/mL VS(0.16±0.0)pg/mL],P<0.05]at D3 in group U.Compared with group C,p300 event-related potential latency was shortened[(302.34±29.12)VS(353.67±35.65),P<0.05],p300 event-related potential latency amplitude increased[(8.11±2.23)VS(5.23±1.93),P<0.05],and the incidence of postoperative cognition decreased at D3 in group U.Conclusion Ulinastatin can prevent and alleviate the postoperative cognition in the elderly patients after laparoscopic total hysterectomy,and has cerebralprotection effect.