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刘静,黄新华,孟志鹏,赵燕.乌司他丁对老年患者腹腔镜子宫全切手术术后认知功能的影响[J].浙江中西医结合杂志,2018,28(8):
乌司他丁对老年患者腹腔镜子宫全切手术术后认知功能的影响
Effect of ulinastatin on postoperative cognition in the elderly patients undergoing laparoscopic total hysterectomyLiu Jing, Huang Xin Hua,zhaoyan . Department of Anesthesiology,Huzhou municipal women and children’s health center,Huzhou310003,Zhejiang province,China.
投稿时间:2018-01-13  修订日期:2018-07-06
DOI:
中文关键词:  乌司他丁  Trendelenberg体位  老年  术后认知功能障碍  神经元特异性烯醇化酶  TNF—a  s-100β 蛋白
英文关键词:ulinastatin  Trendelenberg position  elderly  postoperative cognitive dysfunction  neuron specific eno1ase  TNF—a  s-100β protein
基金项目:湖州市科技局公益性应用研究项目 2016GY33 乌司他丁改善老年妇科手术患者术后认知功能及其与血浆褪黑素水平关系的临床研究
作者单位E-mail
刘静 浙江省湖州市妇幼保健院麻醉科 849796799@qq.com 
黄新华 浙江省湖州市妇幼保健院麻醉科  
孟志鹏 浙江省湖州市中心医院麻醉科  
赵燕 浙江省湖州市妇幼保健院麻醉科  
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中文摘要:
      【】 目的 探讨乌司他丁(ulinastatin,Uli)对老年腹腔镜子宫全切手术后患者认知功能的影响。方法 选择美国麻醉师协会(American society of Anesthesiologists,ASA)Ⅰ或Ⅱ级择期行腹腔镜子宫全切手术的老年患者50 例,随机分为乌司他丁组(U 组)和对照组(C 组)。U组在常规全麻诱导前20min加用乌司他丁20万U溶于100ml生理盐水中,20分钟内静滴完毕,接着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.气腹建立后,所有患者采用40°Trendelenberg体位,于手术前1天(D0)和手术后1 (D1)、3 (D2)、7 (D3)天测定血清白介素-1(IL-1β)、血清白介素-6(IL-6)、血清肿瘤坏死因子(TNF—a)、神经元特异性烯醇化酶(neuron specific eno1ase,NSE)、血清S100β蛋白的含量,并记录简易智力状态检查量表(MMSE)评分,D0和D3测定脑事件相关电位p300潜伏期和振幅。结果 与D0 时间点相比,两组患者在D1、D2时间点均出现MMSE 评分的下降(P<0.05)及IL-1β、IL-6、TNF—a、NSE 、S100β 蛋白表达水平的增高(P<0.05);与C组相比,U组在D1 及D2 时间点 MMSE 评分更高(P<0.05),IL-1β、IL-6、TNF—a、NSE 、S100β 蛋白表达水平更低(P<0.05);U组在D3时MMSE 评分及IL-1β、IL-6、TNF—a、NSE 、S100β蛋白表达水平恢复至术前水平,与C组相比,U组D3时p300潜伏期缩短,振幅升高,术后认知功能障碍发生率降低(P<0.05)。结论 乌司他丁能降低术后IL-1β、IL-6、TNF—a、NSE 、S100β蛋白的表达水平,减轻炎症反应,在一定程度上可减轻或预防老年腹腔镜子宫全切手术患者术后认知功能下降,具有脑保护作用。
英文摘要:
      【】 Objective To evaluate the efficacy of ulinastatin on post-operative cognition in the elderly patients undergoing laparoscopic total hysterectomy .Methods A total of fifty elderly patients(aged65-80 years, American society of Anesthesiologists ASAⅠ-or Ⅱlevel),scheduled for laparoscopic total hysterectomy,were randomly and double-blind divided into 2 groups: using a random number table:ulinastatin group(group U) and control group(group C),25 cases in each group.Patients in group U were given a loading dosage of ulinastatin intravenously 20 ten thousand U which was dissolved in 100ml saline intravenously over 20 min beore the induction of general anesthesia,followed by a continuous infusion of 20 ten thousand U/h,and ulinastatin was administered till the end of surgery.Patiens in group C were given the equal volume of normal saline .After pneumoperitoneum was established ,all the patients were adopted 40°Trendelenberg position.Blood samples were obtained for determination of the plasma concentration of interleukin一1 beta 、interleukin一6、TNF—a 、neuron specific eno1ase,NSE、S100βprotein before the induction of anesthesia
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