| 刘 鸷,刘卫东,朱 炬,白雪波,毕燕琳.盐酸右美托咪定联合乌司他丁对老年腹部手术患者术后认知功能障碍的影响分析[J].,2019,19(12):2352-2356 |
| 盐酸右美托咪定联合乌司他丁对老年腹部手术患者术后认知功能障碍的影响分析 |
| Analysis of the Efficacy of Dexmedetomidine hydrochloride combined with Ulinastatin in the Treatment of Cognitive Dysfunction in the Elderly Patients with Abdominal Surgery |
| 投稿时间：2018-12-13 修订日期：2019-01-10 |
| DOI：10.13241/j.cnki.pmb.2019.12.033 |
| 中文关键词: 盐酸右美托咪定 乌司他丁 老年腹部手术 炎症因子 认知功能障碍 |
| 英文关键词: Dexmedetomidine hydrochloride Ulinastatin Senile abdominal surgery Inflammatory cytokines Cognitive dysfunction |
| 基金项目:山东省自然科学基金项目(ZR2011HL028)；青岛市南区科技发展基金项目(P2014-YY-021) |
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| 中文摘要: |
| 摘要 目的：探讨盐酸右美托咪定联合乌司他丁对老年腹部手术患者术后认知功能障碍的影响及可能机制。方法：选择2018年1月到2018年6月在我院胃肠外科、泌尿外科、肝胆外科行开腹手术的150例患者为研究对象，按照数字表随机分为右美托咪定组、乌司他丁组和联合组，每组各50例患者。比较三组患者的术后苏醒时间、有效镇痛时间、躁动例数及术后认知功能障碍 (POCD)的发生情况，治疗前后血清肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、血清S-100蛋白(S100β)水平、简易智能状态量表(MMSE)评分的变化及不良反应的发生情况。结果：三组患者麻醉苏醒时间比较差异无统计学意义(P>0.05)；联合组患者苏醒期躁动及POCD发生率明显低于右美托咪定组及乌司他丁组，有效镇痛时间明显长于右美托咪定组及乌司他丁组(P<0.05)；治疗后，三组患者血清TNF-α、IL-6及S100β水平均较治疗前明显改善，且联合组患者各个时点血清TNF-α、IL-6及S100β水平均明显低于右美托咪定组及乌司他丁组(P<0.05)。联合组MMSE评分明显高于右美托咪定组及乌司他丁组(P<0.05)。联合组不良反应总发生率为24.00%，显著低于右美托咪定组(50.00%)和乌司他丁组(48.00%)(P<0.05)。结论：与单用盐酸右美托咪定和乌司他丁相比，盐酸右美托咪定联合乌司他丁可更有效预防老年腹部手术患者苏醒躁动及POCD的发生，且安全性更高，可能与其明显降低患者血清炎症因子水平有关。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of dexmedetomidine hydrochloride combined with ulinastatin on the postoperative inflammatory factors and cognitive dysfunction in the elderly patients undergoing abdominal surgery and its possible mechanisms. Methods: 150 cases of patients who underwent open surgery in the gastroenterology, urology and hepatobiliary surgery of our hospital from January 2018 to June 2018 were selected and divided into the dexmedetomidine group, the ulinastatin group and the combined group according to the randomized regimen, with 50 patients in each group. The postoperative recovery time, effective analgesia time, number of agitation cases and postoperative cognitive dysfunction (POCD), changes of serum tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) and S-100 protein (S100β) levels, simple intelligent state scale (MMSE) score before and after treatment and the occurrence of adverse reactions were were compared between the three groups. Results: There was no significant difference in the recovery time of anesthesia among the three groups(P>0.05). The incidence of restlessness and POCD in the combined group was significantly lower than that in the dexmedetomidine group and the ulinastatin group, and the effective analgesia time was significantly longer than that of the dexmedetomidine group and the ulinastatin group(P<0.05). After treatment, the levels of TNF-alpha, IL-6 and S100beta levels in the three groups were significantly improved compared with those before treatment, and the levels of TNF-alpha, IL-6 and S100beta in the combined group were significantly lower than those in dexmedetomidine group and ulinastatin group at all time points(P<0.05). After treatment, the MMSE score of the combined group was significantly higher than that of the dexmedetomidine group and the Ulinastatin group(P<0.05). The total incidence of adverse reactions in combination group was 24.00%, significantly lower than that in dexmedetomidine group (50.00%) and ulinastatin group (48.00%)(P<0.05). Conclusion: Compared with dexmedetomidine hydrochloride and ulinastatin alone, dexmedetomidine hydrochloride combined with ulinastatin can more effectively prevent the emergence of restlessness and POCD in the elderly patients undergoing abdominal surgery with higher safety, which may be related to its significant reduction of serum inflammatory factors. |
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