血塞通对腹腔镜术后患者急性期炎症反应及认知功能的影响

The effect of preoperative application of Xuesaitong on acute inflammatory response and cognitive function of patients after gynecological laparoscopic surgery

目的 探讨血塞通注射液对腹腔镜术后患者急性期炎症反应和认知功能障碍(POCD)的影响.方法 选择2016年7月至2017年9月在四川省广元市中心医院妇产科行妇科腹腔镜手术患者246例,按是否术前使用血塞通将患者分为对照组(118例)和观察组(128例).观察组患者术前30 min静脉滴注(静滴) 400 mg血塞通;对照组术前30 min静滴等量5%葡萄糖注射液,均给药15 min.采用酶联免疫吸附试验(ELISA)测定两组患者术后血清白细胞介素(IL-1、L-6)及肿瘤坏死因子-α(TNF-α)水平;采用神经心理学测试评定患者认知功能状况;采用视觉模拟评分(VAS)量表评估患者术后疼痛情况;记录两组患者手术情况及术后相关风险发生情况.结果 观察组手术时间(min:106.2±30.6比114.6±22.7)、麻醉时间(min:126.1±21.2比122.1±25.3)、术中出血量(mL: 324.4±63.1比313.6±65.1)和术后皮疹(1例比2例)、胸闷(11例比8例)、心悸(10例比8例)、哮喘(5例比4例)、血尿(2例比3例)、伤口出血(4例比3例)、下肢深静脉血栓形成(DVT:11例比14例)患者数和VAS评分(分:3.6±0.9比3.8±0.8)、凝血酶原时间〔PT(s):10.7±2.2比9.7±1.5〕、活化部分凝血活酶时间〔APTT(s):30.3±3.3比30.7±4.3〕、国际标准化比值(INR:0.9±0.1比1.1±0.1)比较差异均无统计学意义(均P>0.05).两组术后IL-1、IL-6及TNF-α水平均随治疗时间延长逐渐降低,于术后12 h达到最低水平,且观察组的变化较对照组更显著〔IL-1(pg/L):3.8±1.0比6.5±1.2,IL-6(pg/L):6.3±1.3比10.3±1.6,TNF-α(pg/L):5.6±1.3比8.4±1.2〕;观察组术后MMSE测试评分(分:25.8±3.1比20.8±3.3)、词汇流畅性测试(分:14.9±1.8比12.8±1.8)均明显高于对照组, POCD发生率明显低于对照组〔18.7%(24/128)比33.8%(40/118),均P<0.05〕.结论 术前使用血塞能降低妇科腹腔镜术后患者急性期血清IL-1、IL-6及TNF-α水平和POCD发生率,且不增加相关风险.

Objective To investigate the effect of Xuesaitong injection on acute inflammatory response and preoperative cognitive dysfunction (POCD) in patients after gynecological laparoscopic surgery. Methods From July 2016 to September 2017, there were 246 patients having undergone gynecological laparoscopic surgery in the Department of Obstetrics and Gynecology of Guangyuan Central Hospital. And according to whether Xueseton was used or not preoperatively, they were divided into a control group (n = 118) and an observation group (n =128). The patients in the observation group were given intravenous drip with 400 mg Xuesaitong at 30 minutes before surgery, while the patients in the control group were given intravenous drip with equal amount of 5% glucose solution at 30 minutes before surgery. The enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin-1 and -6 (IL-1, IL-6) and tumor necrosis factor-α (TNF-α); the neuropsychological tests were used to assess the patients' cognitive function; visual analogue scale (VAS) score was applied to assess the postoperative pain of patients; the intra-operative situation and the postoperative related risk occurrence were recorded in the two groups. Results The comparisons of indicators between the observation group and control group were as follows: the operation time (minutes: 106.2±30.6 vs. 114.6±22.7), anesthesia time (minutes: 126.1±21.2 vs. 122.1±25.3), intra-operative blood loss (mL: 324.4±63.1 vs. 313.6±65.1) and postoperative rash (1 case vs. 2 cases), chest distress (11 cases vs. 8 cases), palpitation (10 cases vs. 8 cases), asthma (5 cases vs. 4 cases), hematuria (2 cases vs. 3 cases), incision bleeding (4 cases vs. 3 cases), lower limb deep venous thrombosis (DVT: 11 cases vs. 14 cases) and VAS score (3.6±0.9 vs. 3.8±0.8), prothrombin time [PT (s): 10.7±2.2 vs. 9.7±1.5], activated partial thromboplastin time [APTT (s): 30.3±3.3 vs. 30.7±4.3], international normalized ratio (INR: 0.9±0.1 vs. 1.1±0.1), all of the above comparisons in indexes between the two groups had no statistical significant differences (all P > 0.05); with prolonged treatment, the IL-1, IL-6 and TNF-α levels were gradually decreased in two groups, reached the lowest levels at 12 hours after surgery, and the changes in the observation group were more significant than those in the control group [IL-1 (pg/L): 3.8±1.0 vs. 6.5±1.2, IL-6 (pg/L): 6.3±1.3 vs. 10.3±1.6, TNF-α (pg/L): 5.6±1.3 vs. 8.4±1.2]; after surgery the scores of MMSE test (score: 25.8±3.1 vs.20.8±3.3) and the word fluency test (14.9±1.8 vs. 12.8±1.8) in the observation group were significantly higher than those in the control group, while the incidence of POCD was significantly lower than that in the control group (18.7% (24/128) vs. 33.8% (40/118), all P < 0.05)Conclusion The use of Xuesaitong before gynecological laparoscopic surgery can reduce the patients' expression levels of serum IL-1, IL-6 and TNF-α at acute inflammatory stage, reduce the occurrence of POCD and does not increase the related risk after surgery.