右美托咪定复合乌司他丁对老年结直肠癌根治术患者术后谵妄的影响

Effect of dexmedetomidine combined with ulinastatin on postoperative delirium in elderly patients with colorectal cancer

目的:探讨右美托咪定复合乌司他丁对老年结直肠癌根治术患者术后谵妄的影响。方法:选取2014年2月-2016年2月于我院进行结直肠癌根治术患者120例为研究对象。将所选患者根据麻醉所用药物的不同分为对照组及观察组,对照组患者在麻醉诱导前予乌司他丁10000U/kg静注,在15～20分钟内静注完成。观察组在麻醉诱导前先予乌司他丁10000U/kg静注,在15～20分钟内静注完成,然后静注剂量为0.5μg/kg的右美托咪定,15分钟后以0.3μg/(kg·h)维持。比较两组患者手术指标、血清儿茶酚胺(多巴胺、肾上腺素、去甲肾上腺素)浓度、血清炎症指标(IL-6、IL-10、S100β)、谵妄发生情况以及药物不良反应。结果:①两组手术时间、术中出血量、输液量、麻醉清醒时间等相关手术指标比较均无统计学意义(P>0.05);②手术结束时与术后第三天两组患者IL-6、S100β、IL-10水平明显高于麻醉前(F=3972.70,1309.30,676.87,498.45,3935.56,735.61;P<0.001);观察组在手术结束时以及术后第三天IL-6、S100β水平明显低于对照组(t=37.896,33.084,20.320,6.789;P<0.001);③对照组手术结束时与术后第三天儿茶酚胺水平明显高于麻醉前(F=101.19,311.24,182.07;P<0.001),观察组手术结束时儿茶酚胺水高于麻醉前,术后第三天恢复至麻醉前(F=3.62,65.08,9.36;P<0.05);手术结束时与术后第三天观察组儿茶酚胺水平明显低于对照组(t=10.868,11.134,12.245,17.456,13.292,9.184;P<0.001);④观察组谵妄发生率明显低于对照组(6.67%vs 20.00%)(χ~2=4.615,P<0.05);⑤观察组出现药物不良反应8例(13.33%),对照组出现药物不良反应5例(8.33%),两组比较,差异无统计学意义。结论:右美托咪定符合乌司他丁可明确抑制结直肠癌患者术后机体炎症因子以及儿茶酚胺类物质的释放,降低谵妄发生率,且两种药物联合使用无严重不良反应,值得临床推广。

Objective:To investigate the effect of dexmedetomidine combined with ulinastatin on postoperative delirium in elderly patients with colorectal cancer.Methods:From February 2014 to February 2016,a total of 120 patients undergoing colorectal cancer radical surgery in our hospital were treated as subjects.The selected patients were divided into control and observation groups according to the drugs used for anesthesia.Patients in the control group were given an ulinastatin 10,000mg/kg intravenously before anesthesia induction,and intravenously completed in 15~20minutes.The observation group was given intravenous infusion of ulinastatin at 10,000U/kg before anesthesia induction,intravenous injection was performed in 15~20minutes,and then 0.5μg/kg dexepamidine was administered intravenously at a dose of 0.3μg/(kg·h).Wo compared the surgical indicators,serum catecholamine concentration,serum inflammation,delirium and adverse drug reactions of the two groups of patients.Results:① There were no significant differences between the two groups in operation time,intraoperative blood loss,infusion volume and anesthesia awake time.②The levels of IL-6,S100βand IL-10 in the two groups were significantly higher than those before anesthesia at the end of the operation and the third day after the operation(F=3972.70,1309.30,676.87,498.45,3935.56,735.61;P<0.001).The level of IL-6and S100βin the observation group were significantly lower than those in the control group(t=-37.896,-33.084,-20.320,-6.789;P<0.001);③ The level of catecholamine in the control group at the end of the operation and the third day after the operation were significantly higher than that before the anesthesia(F=101.19,311.24,182.07;P<0.001).At the end of the operation,the level of catecholamines was higher than that before anesthesia and returned to the anesthesia on the third day after surgery(F=3.62,65.08,9.36;P<0.05),the level of catecholam was significantly lower in the observation group than that in the control group at the end of the operation and the third day after operation(t=10.868,11.134,12.245,17.456,13.292,9.184;P<0.001);④The incidence of delirium in the observation group was significantly lower than that in the control group(χ~2=4.615,P<0.05).⑤There were 8cases(13.33%)of adverse drug reactions in the observation group and 5cases(8.33%)in the control group,there was no significant difference between the two groups.Conclusion:Umevitidine in combination with ulinastatin can clearly inhibit the release of inflammatory factors and catecholamines in colorectal cancer patients,reduce the incidence of delirium,and the combination of these two drugs has no serious adverse reactions,which is worthy of clinical promotion.