乌司他丁对老年肺癌患者手术后认知功能影响的研究

目的研究乌司他丁在治疗老年肺癌患者术后认知过程中的作用。方法选取从2014年2月到2015年1月在我院进行治疗的80例老年肺癌患者,将其分为两组:观察组(40例),对照组(40例)。观察组术中、术后都使用乌司他丁,术中20万U,术后连续使用3天,10万U,溶剂为100ml0.9%氯化钠溶液,静脉注射。对照组仅注射等量0.9%氯化钠溶液。对患者的认知能力:视空间、延迟记忆、注意力、定向、语言方面进行观察;在术前1 d与术后1、3、5、7 d检测两组患者血清IL-6、TNF-α、CRP水平,利用蒙特利尔认知评估量表对两组患者的认知情况进行评价。结果两组患者在手术时间、苏醒时间、出血量、听觉诱发电位(auditory evoked potentials,AEP)指数方面无统计学意义(P0.05)。使用乌司他丁后,由蒙特利尔认知评估量表得出,观察组的视空间评分(4.22±0.33)、延迟记忆评分(3.83±0.66)显著优于对照组的视空间评分(3.29±0.54)、延迟记忆评分(67.8±20.29),具有统计学意义(P0.05)。观察组在术前1 d与术后1、3、5、7 d使用乌司他丁后,血清IL-6、TNF-α、CRP水平均明显升高,具有统计学意义(P0.05),且其值均显著优于对照组(P0.05)。结论乌司他丁能降低老年肺癌患者的IL-6、TNF-α、CRP水平,从而减轻炎症反应,在一定程度上能够降低和预防术后认知能力障碍(post operative cognitive dysfunction,POCD)的发生。

Study on effect of ulinastatin on elderly lung cancer patients after operation of cognition

Objective To study the effect of ulinastatin on cognitive process in elderly patients with lung cancer after treatment. Methods 80 elderly patients with lung cancer from February 2014 to January 2015 were se-lected and they were randomly divided into two groups:the observation group (40 cases) and the control group (40 cases). The observation group was given ulinastatin (200,000 U during operation and 100,000 U for 3 days after the operation), and the solvent was 100ml 0. 9% sodium chloride solution by intravenous injection. The control group was injected with equal amount of 0. 9% sodium chloride solution. The cognitive abilities of patients were observed in the two groups:visual space, delayed memory, attention, orientation and language, and the levels of serum TNF-a, CRP and IL-6 were detected by 1d before and 1, 3, 5, 7 days after the treatment. Results There was no significant difference in operation time, wake-up time, blood loss, and auditory evoked potential ( auditory evoked potentials, AEP) index (P>0. 05). After the use of ulinastatin, the score of space was (4. 2 ± 0. 33), and delayed memory score was (3. 83 ± 0. 66) in the observation group by the Montreal cognitive assessment table, which were significant-ly better than those in the control group [(3. 29 ± 0. 54), (67. 8 ± 20. 29)] (P<0. 05). The levels of serum IL-6, TNF-a and CRP increased significantly ( P<0. 05 ) , and its value was significantly better than those in the control group (P<0. 05). Conclusion Ulinastatin can reduce the levels of IL-6, TNF-a and CRP in elderly patients with lung cancer, reduce inflammation to a certain extent, and prevent the postoperative cognitive dysfunction.