目的 探討注射用烏司他丁聯(lián)合鹽酸右美托咪定注射液對(duì)腹腔鏡下老年結(jié)直腸癌根治術(shù)患者肺功能、認(rèn)知功能和炎性反應(yīng)的影響。方法 選擇2018年2月-2019年12月南陽(yáng)市中心醫(yī)院收治的108例擬行腹腔鏡根治手術(shù)的老年結(jié)直腸癌患者，將患者按照隨機(jī)數(shù)字表法分為右美托咪定組和烏司他丁聯(lián)合右美托咪定組，每組各54例。右美托咪定組患者麻醉誘導(dǎo)前靜脈泵入0.5 μg/kg鹽酸右美托咪定注射液，之后以0.3 μg/（kg·h）持續(xù)泵入至手術(shù)結(jié)束前30 min。烏司他汀聯(lián)合右美托咪定組患者麻醉誘導(dǎo)前靜脈泵入0.5μg/kg鹽酸右美托咪定注射液和2 kU/kg注射用烏司他丁，之后右美托咪定以0.3 μg/（kg·h）持續(xù)靜脈泵入至手術(shù)結(jié)束前30 min，烏司他丁以1 kU/（kg·h）持續(xù)靜脈泵入至手術(shù)結(jié)束。觀察兩組患者術(shù)后認(rèn)知功能、肺功能和炎性因子水平。結(jié)果 術(shù)后，兩組蒙特利爾認(rèn)知評(píng)估（MoCA）評(píng)分、簡(jiǎn)易智能精神狀態(tài)檢查（MMSE）評(píng)分均呈降低趨勢(shì)（P<0.05），并且術(shù)后1、3 d，烏司他丁聯(lián)合右美托咪定組的MoCA評(píng)分、MMSE評(píng)分均高于同期右美托咪定組（P<0.05）。蘇醒后，兩組患者第1秒用力呼氣容積（FEV1）、FEV1/用力肺活量（FVC）、FEV1占預(yù)計(jì)值百分?jǐn)?shù)（FEV1% pred）均顯著降低（P<0.05），烏司他丁聯(lián)合右美托咪定組FEV1、FEV1/FVC、FEV1% pred高于右美托咪定組（P<0.05）。兩組血清白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）、降鈣素原（PCT）、C反應(yīng)蛋白（CRP）水平均先上升后逐漸下降（P<0.05），烏司他丁聯(lián)合右美托咪定組T₁至T₅基線(xiàn)處血清IL-6、TNF-α、PCT、CRP水平明顯低于右美托咪定組（P<0.05）。術(shù)后1、3 d，兩組患者譫妄發(fā)生率均顯著降低（P<0.05）；術(shù)后1 d，烏司他丁聯(lián)合右美托咪定組譫妄發(fā)生率明顯低于右美托咪定組（P<0.05），術(shù)后3 d兩組譫妄發(fā)生率比較無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論 注射用烏司他丁聯(lián)合鹽酸右美托咪定注射液可減少老年結(jié)直腸癌腹腔鏡手術(shù)患者肺功能、認(rèn)知功能的損傷，降低血清炎性因子水平和術(shù)后譫妄的發(fā)生。

Objective To investigate the effect of Ulinastatin for injection combined with Dexmedetomidine Hydrochloride Injection on pulmonary function, cognitive function and inflammatory response in elderly patients undergoing laparoscopic surgery for colorectal cancer. Methods Elderly patients (108 cases) with undergoing laparoscopic surgery for colorectal cancer in Nanyang Central Hospital from February 2018 to December 2019 were randomly divided into dexmedetomidine and ulinastatin combined with dexmedetomidine groups, and each group had 54 cases. Patients in the dexmedetomidine group was given Dexmedetomidine Hydrochloride Injection, 0.5 μg/kg was infused intravenously before anesthesia induction, and then 0.3 μg/(kg·h) was continuously pumped to 30 min before the end of operation. Patients in the ulinastatin combined with dexmedetomidine group was given Dexmedetomidine Hydrochloride Injection (0.5 μg/kg) and Ulinastatin for injection (2 kU/kg) were infused intravenously before anesthesia induction, then dexmedetomidine was continuously pumped at 0.3 μg/(kg·h) until 30 min before the end of operation, and ulinastatin was continuously pumped into the vein at 1 kU/(kg·h) until the end of operation. The cognitive function, lung function and inflammatory factors between two groups were compared. Results After the operation, the MoCA score and MMSE score in two groups were decreased (P < 0.05). After operation for 1 and 3 d, the MOCA score and MMSE score of ulinastatin combined with dexmedetomidine group were higher than those of dexmedetomidine group (P < 0.05). After waking up, FEV1, FEV1/FVC and FEV1% pred in two groups were significantly decreased (P < 0.05). FEV1, FEV1/FVC and FEV1% pred in ulinastatin combined with dexmedetomidine group were higher than those in dexmedetomidine group (P < 0.05). The serum levels of IL-6, TNF-α, PCT and CRP in the two groups increased first and then decreased gradually (P < 0.05). The serum levels of IL-6, TNF-α, PCT and CRP at baseline from T₁ to T₅ in ulinastatin combined with dexmedetomidine group were significantly lower than those in dexmedetomidine group (P < 0.05). After operation for t 1 and 3 d, the incidence of delirium in the two groups were significantly reduced (P < 0.05). After operation for 1 d, the incidence of delirium in ulinastatin combined with dexmedetomidine group was significantly lower than that of dexmedetomidine group (P < 0.05), and after operation for 3 d, there was no significant difference in the incidence of delirium between the two groups. Conclusion Ulinastatin for injection combined with Dexmedetomidine Hydrochloride Injection can reduce the damage of lung function and cognitive function in elderly patients with colorectal cancer undergoing laparoscopic surgery, reduce the serum level of inflammatory factors and postoperative delirium.

R971

河南省科技發(fā)展計(jì)劃項(xiàng)目（152300410163）