右美托咪定联合乌司他丁对腹腔镜手术老年患者术后认知功能障碍的影响

Effect of dexmedetomidine combined with ulinastatin on postoperative cognitive dysfunction in elderly patients undergoing laparoscopic surgery

目的探讨右美托咪定联合乌司他丁对老年腹腔镜手术患者术后认知功能障碍、神经细胞损伤标记物及炎症因子的影响。方法选择河北北方学院附属第一医院2019年10月至2020年12月160例行腹腔镜下结直肠癌手术老年患者,采用随机数字表法分为4组:右美托咪定组(D组)、乌司他丁组(U组)、右美托咪定联合乌司他丁组(DU组)和对照组(N组),各40例。于麻醉诱导前15 min,D组泵注右美托咪定0.5μg/kg,后以0.3μg·kg^(-1)·h^(-1)泵注至手术结束前30 min;U组泵注乌司他丁2 kU/kg,后以1 kU·kg^(-1)·h^(-1)泵注至手术结束前30 min;DU组按照D组和U组给药方式同时给予右美托咪定和乌司他丁;N组泵注等量0.9%氯化钠注射液。记录4组患者术中手术时间、输液量、出血量、尿量、术后苏醒时间;分别于术前(T_(1))、术毕(T_(2))、术后1 d(T_(3))、术后3 d(T_(4))采集颈内静脉血用ELISA检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、神经元特异性烯醇化酶(NSE)和S100β蛋白水平;记录简易精神状态量表(MMSE)评分的变化。结果4组患者麻醉时间、手术时间、输液量、出血量、尿量、术后苏醒时间比较,差异均无统计学意义(P>0.05)。与N组比较,其他3组患者血清TNF-α、IL-1β、NSE和S100β水平在T_(2)~T_(4)均明显降低(P<0.0125),且DU组明显低于D组和U组(P<0.0125),但D组和U组间无明显差异(P>0.05)。术后1 d,DU组MMSE评分较N组明显升高(P<0.0125);术后3 d,各试验组(D组、U组、DU组)均明显高于N组(P<0.0125),且各试验组间无明显差异(P>0.05)。结论与单用右美托咪定和乌司他丁相比,二者联合可更有效地预防老年腹腔镜手术患者POCD的发生,可能与其明显降低患者神经细胞损伤标记物、血清炎症因子水平有关。

Objective To investigate the effects of dexmedetomidine combined with ulinastatin on postoperative cognitive dysfunction,markers of nerve cell injury and inflammatory factors in elderly patients undergoing laparoscopic surgery.Methods A total of 160 elderly patients undergoing laparoscopic colorectal cancer surgery were randomly divided into four groups:the dexmedetomidine group(group D),the ulinastatin group(group U),the dexmedetomidine combined with ulinastatin group(group DU)and the control group(group N),with 40 cases in each group.15 min before anesthesia induction,group D was given dexmedetomidine 0.5μg/kg,then 0.3μg·kg^(-1)·h^(-1) until 30 min before the end of operation;group U was given ulinastatin 2 kU/kg,and then 1 kU·kg^(-1)·h^(-1) until 30 min before the end of operation;group DU was given dexmedetomidine and ulinastatin at the same time according to the way of group D and group U;group N was given the same amount of 0.9%sodium chloride injection.The operation time,infusion volume,blood loss,urine volume and postoperative recovery time of the four groups were recorded.The internal jugular vein blood was collected before operation(T_(1)),after operation(T_(2)),1 day after operation(T_(3))and 3 days after operation(T_(4)),and serum tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),neuron specific enolase(NSE)and S100βprotein(S100β)were detected by ELISA.The changes of mini-mental state examination(MMSE)scorewere recorded.Results There was no significant difference in anesthesia time,operation time,infusion volume,blood loss,urine volume and postoperative recovery time among the four groups(P>0.05).Compared with group N,the serum concentrations of TNF-α,IL-1β,NSE and S100βin the other three groups were significantly lower at T_(2)-T_(4)(P<0.0125),and the levels in group DU were significantly lower than those in group D and group U(P<0.0125),but there was no significant difference between group D and group U(P>0.05).The MMSE score of group DU was significantly higher than that of group N on the 1st day after operation(P<0.0125);the MMSE score of the experimental groups(group D,U,DU)was significantly higher than that of group N on the 3rd day after operation(P<0.0125),and there was no significant difference among the experimental groups(P>0.05).Conclusion Compared with using dexmedetomidine and ulinastatin alone,dexmedetomidine combined with ulinastatin can more effectively prevent POCD in elderly patients undergoing laparoscopic surgery,which may be related to the significantly reduced levels of nerve cell injury markers and serum inflammatory factors.