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乌司他丁对老年腹部手术患者炎性因子及术后认知功能障碍的影响
Effects of ulinastatin on inflammations reaction and postoperative cognition disorders in elderly patients undergoing abdominal surgery
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DOI:
作者:
刘哲
liu zhe
作者单位:
上海市浦东新区公利医院
GongLi Hospital, Pudong, Shanghai,
关键词:
术后认知功能障碍 乌司他丁 炎性细胞因子
Postoperative cognitive disfunction; Ulinastain; inflammatory cytokines
摘要:
目的:本研究旨在探讨乌司他丁对老年手术患者相关炎性细胞因子及术后认知功能障碍(POCD)的影响。方法:100例65岁以上行腹部手术老年患者随机分为对照组(C组)及乌司他丁组(U组,术前30min给予乌司他丁1万U/kg),分别检测患者在麻醉诱导前、术后6小时、术后3天血浆炎性细胞因子Il-6、IL-8、IL-10水平,并评定术前及术后1 周内的认知功能。 结果:术后1 周U组术后认知功能障碍发生率明显低于C组;两组患者术后血浆IL-6、IL-8、IL-10水平均较术前升高。血浆促炎性细胞因子IL-6、IL-8水平在术后C组明显高于U组。而抗炎性细胞因子IL-10水平C组明显低于U组。且C组血浆IL-6/IL-10比值明显高于U组。结论:乌司他丁抑制促炎性细胞因子(IL-6、IL-8)的增多,促进抗炎性细胞因子(IL-10)的产生,减少POCD的发生。
Objective To investigate the effects of ulinastatin on inflammation reaction and postoperative cognitive disfunction (POCD) in patients undergoing abdominal surgery. Methods 100 patients undergoing abdominal surgery were divided into two groups as follows: Control group (group C, untreated, n = 50) and ulinastain group (group U, 10,000 U/kg of ulinastain were injected intravenously at 30min before operation, n= 50). The levels of plasa Il-6、IL-8、IL-10 were detected before surgery (T1), 6 hour after surgery (T2) and 3 day after surgery(T3). All patients were checked cognitive score with battery of cognitive assessment instruments(BCAI) at 1d preoperation and 7d postoperation. Results The incidence of POCD in Group U (17 patients) was significantly lower than that in Group C (29 patients). The plasma concentrations of IL-6, IL-8, IL-10 of two groups at time point of T2 or T3 were significantly higher than those at T1 point. Compared to Group C, the plasma concentrations of IL-6, IL-8 in Group U were significantly lower and IL-10 in Group U was higher at time point of T2 or T3. The ratio of plasma IL-6/IL-10 of two groups at time point of T2 and T3 were significantly higher than those at T1 point, and Group C was higher than Group U at time point of T2 and T3. Conclusion: Prophylactic of ulinastain in patients undergoing abdominal surgery can decrease the incidence of POCD. The possible mechanism was that ulinastain could modulate the balance of proinflammatory cytokine(IL-6、IL-8) and anti-inflammatory cytokines(IL-10).
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