乌司他丁联合右美托咪定对腹腔镜下老年结直肠癌根治术患者肺功能、认知功能和炎性反应的影响

目的探讨注射用乌司他丁联合盐酸右美托咪定注射液对腹腔镜下老年结直肠癌根治术患者肺功能、认知功能和炎性反应的影响。方法选择2018年2月—2019年12月南阳市中心医院收治的108例拟行腹腔镜根治手术的老年结直肠癌患者,将患者按照随机数字表法分为右美托咪定组和乌司他丁联合右美托咪定组,每组各54例。右美托咪定组患者麻醉诱导前静脉泵入0.5μg/kg盐酸右美托咪定注射液,之后以0.3μg/(kg·h)持续泵入至手术结束前30 min。乌司他汀联合右美托咪定组患者麻醉诱导前静脉泵入0.5μg/kg盐酸右美托咪定注射液和2 kU/kg注射用乌司他丁,之后右美托咪定以0.3μg/(kg·h)持续静脉泵入至手术结束前30 min,乌司他丁以1 kU/(kg·h)持续静脉泵入至手术结束。观察两组患者术后认知功能、肺功能和炎性因子水平。结果术后,两组蒙特利尔认知评估(Mo CA)评分、简易智能精神状态检查(MMSE)评分均呈降低趋势(P0.05),并且术后1、3 d,乌司他丁联合右美托咪定组的Mo CA评分、MMSE评分均高于同期右美托咪定组(P0.05)。苏醒后,两组患者第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、FEV1占预计值百分数(FEV1%pred)均显著降低(P0.05),乌司他丁联合右美托咪定组FEV1、FEV1/FVC、FEV1%pred高于右美托咪定组(P0.05)。两组血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)水平均先上升后逐渐下降(P0.05),乌司他丁联合右美托咪定组T1至T5基线处血清IL-6、TNF-α、PCT、CRP水平明显低于右美托咪定组(P0.05)。术后1、3 d,两组患者谵妄发生率均显著降低(P0.05);术后1 d,乌司他丁联合右美托咪定组谵妄发生率明显低于右美托咪定组(P0.05),术后3d两组谵妄发生率比较无统计学差异。结论注射用乌司他丁联合盐酸右美托咪定注射液可减少老年结直肠癌腹腔镜手术患者肺功能、认知功能的损伤,降低血清炎性因子水平和术后谵妄的发生。

Effect of ulinastatin combined with dexmedetomidine on pulmonary function, cognitive function and inflammatory response in elderly patients undergoing laparoscopic surgery for colorectal cancer

Objective To observe the clinical efficacy and safety of Salvianolic Acid for Injection in the treatment of acute cerebral infarction belong to blood stasis syndrome in traditional Chinese medicine. Methods A total of 85 patients with acute cerebral infarction belong to blood stasis syndrome in Traditional Chinese Medicine (TCM) in Anyang Traditional Chinese Medicine Hospital from July 2018 to July 2019 were selected and divided randomly into control group (43 cases) and observation group (42 cases). The control group was given antiplatelet aggregation, blood pressure and blood glucose control, free scavenger drugs. The observation group treated with Salvianolic Acid for Injection 0.13 g added into 250 mL sodium chloride injection for intravenous infusion once a day on the basis of control group. Both groups were treated for 2 weeks. The NIHSS scores, ADL scores, ischemic penumbra, therapeutic effects, and adverse reactions were compared between two groups before and after treatment. Results The NIHSS scores, ADL scores, and ischemic penumbra were no statistical difference between two groups before treatment. After treatment, the ischemic penumbra, NIHSS and ADL scores in two groups were improved (P<0.05), and the three indexes in observation group were better than those in control group (P<0.05). The clinical total effective rate in observation group was 93%, while it was 77% in control group, observation group was significantly higher than control group (P<0.05). The syndrome of blood stasis in TCM total effective rate in observation group was 95.2%, while it was 72.0% in control group, observation group was significantly higher than control group (P<0.05). There was no adverse reactions in two groups. Conclusion the therapeutic effect of Salvianolic Acid for Injection in the treatment of acute cerebral infarction is exact, which may be based on the effective treatment of ischemic penumbra after acute cerebral infarction and play a neuroprotective role.