乌司他丁联合右美托咪定对老年食管癌患者术后认知功能的影响

目的 观察乌司他丁联合右美托咪定(dexmedetomidine,Dex)麻醉对老年食管癌患者术后早期认知功能的影响. 方法 拟行择期手术的老年食管癌患者60例,年龄65～84岁,ASA分级Ⅰ～Ⅲ级.采用随机数字表法将患者分为干预组(Ⅰ组)和对照组(Ⅱ组),每组30例.气管插管后,Ⅰ组乌司他丁2×105 U,溶于100 ml生理盐水,30 min内静脉滴注,Dex 0.5 μg·kg-1·h-1泵注至手术结束前0.5 h;Ⅱ组静脉滴注等容量的生理盐水.分别在术前1d和术后1、3d对患者进行神经心理学测试,计算术后成绩与术前基础值的差值(X值),记录术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生情况.分别于麻醉诱导前(T0)、术毕时(T1)、术后1 d(T2)及术后3 d(T3)抽取外周动脉血,ELISA法分别检测S-100β蛋白、神经元特异性烯醇化酶(neuron-specific enolase,NSE)及IL-6浓度. 结果 X值比较:与Ⅱ组比较,Ⅰ组数字符号测试、累加测试及循迹连线测试A均显著降低(P＜0.05).Ⅰ组和Ⅱ组POCD发生率分别为6.7％和30.0％,Ⅰ组显著低于Ⅱ组(P＜0.05).T1时点,Ⅰ组S-100β蛋白、NSE及IL-6浓度均显著低于Ⅱ组(P＜0.05);T2时点,Ⅰ组NSE及IL-6浓度均显著低于Ⅱ组(P＜0.05);T3时点,Ⅰ组IL-6浓度显著低于Ⅱ组(P＜0.05). 结论 乌司他丁联合Dex麻醉可以降低老年食管癌患者早期POCD的发生率,可能与其降低血清S-100β蛋白、NSE及IL-6浓度有关.

Effects of ulinastatin combined with dexmedetomidine on early postoperative cognitive function in elderly patients undergoing esophageal cancer surgery

Objective To observe the effects of ulinastatin conbined with dexmedetomidine (Dex) on early postoperative cognitive function in elderly patients undergoing esophageal cancer operations.Methods Sixty patients (ASA Ⅰ-Ⅲ,aged 65-84 y) scheduled for surgeries for esophageal cancer were randomized into intervention group (group Ⅰ,n=30) and control group (group Ⅱ,n=30).After intravenous induction and tracheal intubation,the patients in the intervention group Ⅰ were infused intravenously 2×105 U ulinastatin in 100 ml normal saline in 30 min and Dex 0.5 μg·kg-1·h-1 to 30 min before end of the operation,the patients in group Ⅱ received the same volume of saline infusion only.Comprehensive neuro-psychological tests were performed at day 1 before and day 1,3 after operation to assess preopereative cognitive function of patients.Peripheral artery blood was extracted to determine levels of serum S-100β protein,neuron-specific enolase(NSE) and IL-6 with ELISA before anesthesia induction(T0),at the end of the surgery (T1),and at day 1 (T2) and day 3 (T3) after operation.Results The difference between the test scores before and after the operation (X values) was significantly smaller in the group Ⅰ than in the group Ⅱ (P＜0.05).The group Ⅰ showed a significantly lower incidence rate of postoperative cognitive dysfunction (POCD) than the group Ⅱ (6.7％ vs 30.0％,P＜0.05).Compared with the group Ⅱ,the group Ⅰ exhibited significantly lower serum levels of S-100β protein,NSE and IL-6 at T1 (P＜0.05),significantly lower NSE and IL-6 levels at T2 (P＜0.05) time point,and significantly lower IL-6 level at T3 (P＜0.05).Conclusions Intravenous injection of ulinastatin and Dex during the operation can reduce the incidence of POCD in elderly patients undergoing surgeries for esophageal tumors possibly in relation to decreased serum S-100β,NSE and IL-6 levels.