CAJ | 학술논문

目的探讨使用乌司他丁调节全身炎性反应对老年人七氟烷吸入麻醉术后认知功能的影响.方法 60例择期行上腹部手术的患者随机双盲法分为持续静脉泵注乌司他丁0.2万u·kg-1·h-1(A组)和持续静脉泵注等量0.9%氯化钠注射液(B组),每组30例.观察睁眼、拔管、应答时间,观察不同时间点简易精神状态量表得分及超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、IL-10的浓度变化.结果两组患者应答时间A组少于B组(F=4.399,P=0.040).两组患者术后1 h较术前均出现了MMSE评分下降(t=7.732、11.916,均P＜0.01),评分小于术前值超过2分,认为患者认知功能下降,但A组MMSE评分下降的幅度低于B组(F=7.582,P=0.012);两组患者术后6 h较术前均出现了MMSE评分下降(t=4.606、8.615,均P＜0.05),A组评分小于术前值未超过2分,B组评分小于术前值超过2分,但两组间差异无统计学意义(P＞0.05).两组患者术后1 d、3 d、7 d的hs-CRP、IL-6、IL-10均出现升高(均P＜0.01),高峰出现在术后1 d,术后7 d仍未降至术前水平;A组术后1 d、3 d的hs-CRP、IL-6升高的幅度低于B组(F=14.885,P=0.000;F=4.405,P=0.040;F=18.204,P=0.000;F=8.074,P=0.006),但A组术后1 d、3 d的IL-10升高的幅度高于B组(F=5.197,P=0.026;F=12.236,P=0.000).结论乌司他丁可以促使老年人七氟烷吸入麻醉术后认知功能的快速恢复,其机制可能与其调节全身炎性反应有关.
목적 탐토사용오사타정조절전신염성반응대노년인칠불완흡입마취술후인지공능적영향.방법 60례택기행상복부수술적환자수궤쌍맹법분위지속정맥빙주오사타정0.2만u·kg-1·h-1(A조)화지속정맥빙주등량0.9%록화납주사액(B조),매조30례.관찰정안、발관、응답시간,관찰불동시간점간역정신상태량표득분급초민C반응단백(hs-CRP)、백세포개소-6(IL-6)、IL-10적농도변화.결과 량조환자응답시간A조소우B조(F=4.399,P=0.040).량조환자술후1 h교술전균출현료MMSE평분하강(t=7.732、11.916,균P＜0.01),평분소우술전치초과2분,인위환자인지공능하강,단A조MMSE평분하강적폭도저우B조(F=7.582,P=0.012);량조환자술후6 h교술전균출현료MMSE평분하강(t=4.606、8.615,균P＜0.05),A조평분소우술전치미초과2분,B조평분소우술전치초과2분,단량조간차이무통계학의의(P＞0.05).량조환자술후1 d、3 d、7 d적hs-CRP、IL-6、IL-10균출현승고(균P＜0.01),고봉출현재술후1 d,술후7 d잉미강지술전수평;A조술후1 d、3 d적hs-CRP、IL-6승고적폭도저우B조(F=14.885,P=0.000;F=4.405,P=0.040;F=18.204,P=0.000;F=8.074,P=0.006),단A조술후1 d、3 d적IL-10승고적폭도고우B조(F=5.197,P=0.026;F=12.236,P=0.000).결론 오사타정가이촉사노년인칠불완흡입마취술후인지공능적쾌속회복,기궤제가능여기조절전신염성반응유관.
Objective To research the effect of regulating systemic inflammatory response by using ulinastatin in elderly patients after sevoflurane inhalation of postoperation cognitive function. Methods 60 patients under went elective abdominal surgery, were randomly double-blinded divided into 2 groups. Every group had 30 patients.Group A accepted continuously intravenousiy infusion ulinastatin 2000 units · kg-1 · h-1 , while group B got equivalent continuously intravenous infusion 0.9% sodium chloride injection. The time point of opening eye, extubation, response and the mini-mental state examination(MMSE) score on different time points were observed. Meanwhile, the changes of concentration of hs-CRP, IL-6,IL-10 were measured. Results Compared with two groups,group A has shorter time on response(F =4.399,P = 0.040). Two both groups had decrease of MMSE score 1 hour after surgery compared with preoperation(t =7. 732,11. 916, both P ＜ 0.01), and the score were less than the preoperative value of more than 2 points which showed cognitive decline in patients. But group A's rate of decline in MMSE score was lower than group B(F = 7. 582 ,P =0.012). Both groups had the MMSE score decline 6h after surgery (t = 4. 606,8. 615, both P ＜ 0.05). Group A's score was less than the preoperative value for less than 2 points, group B's score was lower than the preoperative value for more than 2 points, but the difference between the two groups was not significant (P ＞0. 05). Both groups had higher concentrations of hs-CRP、IL-6 、IL-10 at postoperative 1 d ,3d ,7d (all P ＜ 0.01), peaked at postoperative 1 d, and hadn't come back to the preoperative level 7d*after surgery. In group A, the concentrations of hs-CRP, IL-6 increased (postoperative 1 d,3d), but the rate was lower than the group B (F = 14. 885, P = 0.000;F = 4. 405, P = 0. 040; F = 18. 204, P = 0.000; F = 8. 074, P = 0. 006); while the increased rate of concentration of IL-10 was higher than the group B(F=5.197,P=0.026;F= 12.236,P =0.000). Conclusion Ulinastatin could promote the elderly after sevoflurane inhalation rapid recovery of cognitive function, which may be related to the regulation of systemic inflammatory response.