不同剂量乌司他丁对老年直肠癌患者腔镜术后早期认知功能的影响及机制探讨

摘要

Objective To investigate the effects of different doses of ulinastatin on early postoperative cognitive function in elderly patients undergoing radical resection of rectal carcinoma,and explore the mechanism of the effect from the aspects of inflammation,immunity and oxidative stress.Methods Clinical data of patients who are going to receive radical resection for rectal carcinoma with the help of laparoscope in our hospital from August 2013 to March 2016 was prospectively collected and analyzed.Totally 112 cases were randomly divided into 3 groups according to the dosing regimen of ulinastatin,group A (n =35,ulinastatin 10 000 U/kg),group B (n =37,ulinastatin 15 000 U/kg) and group C (n =40,normal saline).The baseline data,postoperative cognitive function,and the indexes of inflammatory,immune and oxidative stress among three groups were compared.Results There were significant differences in the postoperative cognitive function and the indexes of inflammatory,immune and oxidative stress on the 3rd postoperative day among the three groups (P ＜0.05).The levels of MMSE scores,CD4+ ％,CD4 +/CD8 +,CD16+/CD56 +,GSH and SOD were highest in group B and lowest in group C (P ＜ 0.05).The POCD incidence and the levels of S100β,CRP,TNF-α and MDA were the lowest in group B and highest in group C (P ＜ 0.05).Conclusion Ulinastatin can significantly reduce the incidence of postoperative POCD in patients with laparoscopic rectal cancer probably by inhibiting inflammation and oxidative stress reaction and improving immune status,and the effect of high-dose ulinastatin is better.%目的 探讨不同剂量乌司他丁对老年直肠癌根治术患者术后早期认知功能的影响,并从炎症、免疫及氧化应激角度探讨其影响机制.方法 前瞻性收集、分析2013年8月至2016年3月于我院普通外科拟行腔镜辅助下直肠癌根治术患者的临床资料.112例入组患者根据乌司他丁的给药方案随机分为3组:A组,35例,乌司他丁10 000 U/kg;B组,37例,鸟司他丁15 000 U/kg;C组,40例,等量生理盐水.比较三组患者的基线资料、术后认知功能、炎症、免疫及氧化应激等相关指标.结果 三组患者术后3d时的认知功能、炎症、免疫及氧化应激指标组间比较差异有统计学意义(P＜0.05),且B组MMSE评分、CD4+％、CE4 +/CD8+、CD16+/CD56+、GSH及SOD水平最高,C组最低(P＜0.05);B组POCD发生率、S100β、CRP、TNF-α、MDA水平最低,C组最高(P＜0.05).结论 乌司他丁可以显著降低腔镜直肠癌患者术后POCD发生率,且剂量高者效果更佳,机制可能与乌司他丁抑制炎症、氧化应激反应及改善免疫状态有关.