乌司他丁对老年单孔胸腹腔镜食管癌根治术术后谵妄的影响

Effects of ulinastatin on postoperative delirium in elderly patients receiving esophageal cancer surgery with laparoscopy combined thoracoscopy in a single hole

目的探讨麻醉诱导前静脉注射乌司他丁对老年患者单孔充气式纵膈镜联合腹腔镜食管癌根治术术后谵妄(POD)的影响。方法择期行单孔充气式纵膈镜联合腹腔镜食管癌根治术老年患者68例,随机分为乌司他丁组和对照组,每组34例。麻醉诱导前,乌司他丁组静脉注射乌司他丁10000 U·kg^-1,对照组静脉注射等容量氯化钠注射液。评估POD发生率,检测麻醉前(T0)、术毕(T1)和术后第3日(T2)患者血清白细胞介素6(IL-6)和S100β水平。结果发生POD共13例,其中对照组11例(32%),乌司他丁组2例(6%),乌司他丁组POD发生率显著低于对照组(P<0.01)。与T0时比较,2组T1、T2时IL-6水平和T1时S100β水平均升高(P<0.05),乌司他丁组T1、T2时IL-6水平和T1时S100β水平低于对照组(P<0.05)。对照组和乌司他丁组的药物不良反应发生率分别为21%和24%,无显著差异(P>0.05)。结论麻醉诱导前静脉注射乌司他丁能够有效预防单孔纵膈镜联合腹腔镜食管癌根治手术老年患者POD的发生,可能与抑制术后炎症介质水平有关。

AIM To investigate the effects of intravenous infusion of ulinastatin before anesthesia induction on postoperative delirium(POD)in elderly patients receiving esophageal cancer surgery with laparoscopy combined thoracoscopy in a single hole.METHODS Sixty-eight elderly patients receiving selective esophageal cancer surgery with laparoscopy combined thoracoscopy in a single hole were randomly divided into two groups:ulinastatin group(group U)and control group(group C),34 in each.Before anesthesia,the patients were injected with ulinastatin 10000 U·kg^-1 in the group U and same volume sodium chloride injection in the group C.The incidence of POD was recorded and the serum levels of IL-6 and S100βbefore anesthesia(T0),end of the operation(T1)and postoperative day 3(T2)were tested.RESULTS There were 13 cases of POD,including 11 cases(32%)in the group C and 2 in the group U(6%).The incidence of POD in the group U was significantly lower than that in the group C(P<0.01).Compared with T0,IL-6 and S100βlevels at T1 and T2 were significantly increased in the group C and group U(P<0.05).Compared with group C,IL-6 levels at T1,T2 and S100βlevel at T1 were significantly decreased in the group U(P<0.05).The total incidences of adverse drug reaction were 21%and 26%in the group C and group U,without significant difference(P>0.05).CONCLUSION Intravenous injection of ulinastatin before anesthesia induction can reduce incidence of POD in elderly patients receiving esophageal cancer surgery with laparoscopy combined thoracoscopy in a single hole,which may be related to inhibiting postoperative inflammatory mediator levels.