|
| 乌司他丁对老年患者腹腔镜子宫全切手术后早期褪黑素水平和认知功能的影响 |
| Effect of ulinastatin on the postoperative melatonin level and cognitive function of gerontic patients undergoing laparoscopictotal hysterectomy |
| |
| DOI：10.12089/jca.2018.08.004 |
| 中文关键词: 乌司他丁 老年 子宫全切术 术后认知功能 褪黑素 |
| 英文关键词: Ulinastatin Elderly Total hysterectomy Postoperative cognition Melatonin |
| 基金项目:湖州市科技局公益性应用研究项目(2016GY33) |
|
| 摘要点击次数: 3579 |
| 全文下载次数: 1221 |
| 中文摘要: |
目的 观察乌司他丁对老年患者腹腔镜子宫全切手术后早期褪黑素水平和认知功能的影响。
方法 选择择期行腹腔镜子宫全切术患者60例,年龄65～80岁,BMI 18～30 kg/m2,ASA Ⅰ—Ⅲ级。随机分为乌司他丁组(U组)和对照组(C组),每组30例。U组在常规全麻诱导前用乌司他丁20万U+生理盐水100 ml,持续静脉泵注乌司他丁20万U/h直至手术结束。C组给予相应生理盐水静脉输注,两组患者均采用快诱导和全凭静脉麻醉。记录麻醉时间、术中输液量、尿量、出血量、瑞芬太尼及丙泊酚用量;检测术前1 d(T0)、术后第1天(T1)、术后第3天 (T2) 、术后第7天(T3)血清IL-1β、IL-6、TNF-α浓度、神经元特异性烯醇化酶(neuron specific enolase,NSE)和S100β蛋白含量;血T淋巴细胞(CD3+、CD4+、CD8+)、计算CD4+/CD8+比值、血浆褪黑素浓度及采用蒙特利尔认知评估表(MoCA)评分评估患者的认知功能。术前1 d和术后第7天测定脑事件相关电位P300潜伏期和振幅。
结果 与T0时比较,T1—T2时两组IL-1β、IL-6、TNF-α、NSE、S100β蛋白含量明显增高(P<0.05),但U组明显低于C组(P<0.05);血浆褪黑素浓度、CD3+、CD4+细胞含量、CD4+/CD8+比值及MoCA评分明显下降(P<0.05),但U组明显高于C组(P<0.05);与C组比较,术后第7天U组P300潜伏期明显缩短,振幅明显升高,术后认知功能下降发生率明显降低(P<0.05)。
结论 腹腔镜子宫全切术刺激可明显降低血浆褪黑素浓度及术后早期认知功能,乌司他丁干预可减缓这一趋势。 |
| 英文摘要: |
Objective To observe the influence of ulinastatin on the postoperative melatonin level and cognition function of the elderly patients undergoing laparoscopic total hysterectomy.
Methods Sixty elderly patients, aged 65 - 80 years, BMI 18 - 30 kg/m2, ASA physical status Ⅰ - Ⅲ, scheduled for laparoscopictotal hysterectomy, were randomly divided into 2 groups using a random number table: ulinastatin group (group U) and control group (group C), 30 cases in each. Patients in group U were given a loading dosage of ulinastatin intravenously 200 000 U which was dissolved in 100 ml saline beore the induction of general anesthesia, followed by a continuous infusion of ulinastatin of 200 000 U/h, till the end of surgery. Patiens in group C were given the equal volume of normal saline. The two groups received rapid induction of general anaesthesia and total intravenous general anesthesia. The time of anesthesia,intraoperative infusion volume, urine volume, the amount of bleeding, refentanil and propofol dosage were recorded. Blood samples were obtained for determination of the plasma concentration of interleukin-1 beta, interleukin-6, TNF-α, neuron specific enolase, NSE, S100β protein, levels of plasma melatonin, T lymphocyte (CD3+, CD4+, CD8+), CD4+/CD8+ ratio was calculated before the induction of anesthesia within the preoperative 1 d (T0), within the postoperative 1 d (T1), 3 d (T2), 7 d (T3), while the score of MoCA was recorded to evaluate the cognitive function at the same time. P300 event-related potential latency and amplitude were determined at T0 and T3. The incidence rate of postoperative cognitive decline, levels of plasma melatonin, inflammatory factor and the change of the index of correlation were observed in the two groups.
Results Compared with T0, the levels of IL-1β, IL-6,TNF-α, NSE, S100β protein were significantly increased in both groups at T1 and T2(P < 0.05), but they were lower in group U than in group C (P < 0.05). Compared with T0, levels of plasma melatonin, T lymphocyte (CD3+, CD4+), CD4+/CD8+ and the scores of MoCA were significantly decreased in both groups at T1 and T2 (P < 0.05), but they were higher in group U than in group C (P < 0.05). Compared with group C, P300 event-related potential latency was shortened, P300 event-related potential latency amplitude was increased, and the incidence of postoperative cognitive decline was lower in group U on the postoperative 7th day (P < 0.05).
Conclusion The stimulation of laparoscopictotal hysterectomy can obviously reduce the levels of plasma melatonin and early stage postoperative cognitive function, which can be relieved by ulinastatin. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
