乌司他丁联合右美托咪定对胃癌根治术全身麻醉患者术后认知功能及中枢神经特异性蛋白水平的影响

Effect of ulinastatin combined with dexmedetomidine on postoperative cognitive function and central nervous specific protein S100βin patients undergoing radical gastrectomy for gastric cancer with general anesthesia

目的探究乌司他丁联合右美托咪定对胃癌根治术全身麻醉患者术后认知功能及中枢神经特异性蛋白(S100β蛋白)水平的影响。方法选取2018年1月至2019年6月在黔东南苗族侗族自治州人民医院接受治疗的择期胃癌根治术患者100例作为研究对象。采用随机数字表法分为A组(右美托咪定辅助全身麻醉)和B组(乌司他丁联合右美托咪定辅助全身麻醉),各50例。观察2组患者脑电双频指数(BIS)值、麻醉相关时间指标、简易智力状态检查量表(MMSE)评分、血清S100β蛋白水平和术后相关指标。结果麻醉后5、15、30 min时B组患者BIS值显著低于A组,且麻醉起效时间、苏醒时间和定向力恢复时间均显著短于A组,差异均有统计学意义(均P<0.05)。B组患者在术后1、3 d时MMSE评分高于A组,血清S100β蛋白水平低于A组[MMSE评分:(25.5±1.7)分比(23.1±1.2)分、(27.2±1.5)分比(25.8±0.4)分,S100β蛋白:(150±24)ng/L比(226±43)ng/L、(107±19)ng/L比(166±50)ng/L],差异均有统计学意义(均P<0.05)。B组患者术后睁眼时间、丙泊酚总用量、自主呼吸恢复时间、拔管时间和不良反应发生率短于/少于/低于A组,差异均有统计学意义(均P<0.05)。结论乌司他丁联合右美托咪定能够提高胃癌根治术全身麻醉患者的麻醉效果,改善术后认知功能,降低S100β蛋白水平。

Objective To investigate the effect of ulinastatin combined with dexmedetomidine on postoperative cognitive function and central nervous specific protein S100βlevel in gastric cancer patients undergoing radical gastrectomy with general anesthesia.Methods One hundred patients with gastric cancer undergoing elective radical gastrectomy in People’s Hospital of Miao and Dong Autonomous Prefectures,Southeast Guizhou from January2018 to June 2019 were enrolled.They were randomly divided into group A(general anesthesia with dexmedetomidine)and group B(general anesthesia with ulinastatin and dexmedetomidine),with 50 patients in each group.Bispectral index(BIS),anesthesia indexes,Mini-Mental State Examination(MMSE)score,serum level of S100βprotein and postoperative recovery indexes were analyzed.Results BIS values in group B were significantly lower than those in group A at 5,15 and 30 min after anesthesia;anesthesia onset time,recovery time and orientation recovery time in group B were significantly shorter than those in group A(all P<0.05).MMSE score was higher and serum S100βprotein level was lower in group B than those in group A at 1 and 3 days after surgery[MMSE score:(25.5±1.7)vs(23.1±1.2),(27.2±1.5)vs(25.8±0.4);S100βprotein:(150±24)ng/L vs(226±43)ng/L,(107±19)ng/L vs(166±50)ng/L](all P<0.05).Postoperative wakening time,total propofol dose,spontaneous breathing recovery time,extubation time and adverse reaction rate in group B were significantly shorter/less/lower than those in group A(all P<0.05).Conclusion Ulinastatin combined with dexmedetomidine can improve the anesthetic effect onpatients with radical gastrectomy,improve postoperative cognitive function and reduce serum level of S100βprotein.