2022 年第 3 期 第 17 卷

乌司他丁预应用对达芬奇机器人前列腺癌根治术老年患者术后炎症因子及认知功能的影响

Effects of prior-use of ulinastatin on inflammatory factors and cognitive function in elderly patients after radical prostatectomy with Da Vinci robot

作者：周丹王庆利秦明哲汪宏余胭程鹏飞

英文作者：Zhou Dan Wang Qingli Qin Mingzhe Wang Hong Yu Yan Cheng Pengfei

单位：中国人民解放军中部战区总医院麻醉科，武汉430070

英文单位：Department of Anesthesiology Central Theater General Hospital of the Chinese People′s Liberation Army Wuhan 430070 China

关键词：前列腺癌根治术；乌司他丁；炎症因子；认知功能

英文关键词：Radicalprostatectomy;Ulinastatin;Inflammatoryfactor;Cognitivefunction

• 摘要：

• 目的 探讨乌司他丁预应用对达芬奇机器人辅助腹腔镜下前列腺癌根治术（RALRP）老年患者术后炎症因子及认知功能的影响。方法  选择中国人民解放军中部战区总医院2018年7月至2020年6月在全身麻醉下行RALRP的老年患者100例，应用随机数字表法将其分为观察组和对照组，每组50例。观察组在手术切皮前30 min静脉滴注乌司他丁，对照组在手术切皮前30 min静脉滴注等容积0.9%氯化钠注射液。比较2组患者围术期生命体征及术后炎症因子变化。用简易智力状态检查量表（MMSE）评分和Z计分法评估患者术后认知功能。结果 2组患者围术期生命体征差异均无统计学意义（均P>0.05）。观察组术后第1、2天血清白细胞介素1、白细胞介素6水平及术后第1、2、3天血清肿瘤坏死因子α、高敏C反应蛋白水平均明显低于对照组，术后不同时点MMSE评分均明显高于对照组（均P<0.05）。观察组患者术后7 d和术后1个月认知功能障碍发生率均低于对照组［10.0%（5/50）比34.0%（17/50）、6.0%（3/50）比18.0%（9/50）］，差异均有统计学意义（χ2=8.392，P=0.003； χ2=4.332，P=0.038）。结论  乌司他丁术前预应用于RALRP老年患者可有效抑制全身炎症因子的释放，降低术后认知功能障碍发生率。

• Objective   To investigate the effects of prior-use of ulinastatin on inflammatory factors and cognitive function in elderly patients after Robotic assisted laparoscopic radical prostatectomy(RALRP). Methods   From July 2018 to June 2020, 100 elderly patients undergoing RALRP under general anesthesia in Central Theater General Hospital of the Chinese People′s Liberation Army were selected. The patients were randomly divided into observation group and control group, with 50 cases in each group. The observation group was given ulinastatin intravenously 30 min before skin resection, and the control group was given equal volume of 0.9% sodium chloride injection 30 min before skin resection. Perioperative vital signs and postoperative inflammatory factors were compared between the two groups. Mini-mental state examination (MMSE) and Z-score were used to evaluate the cognitive function of the patients after surgery. Results  There was no significant difference in perioperative vital signs between the two groups(all P>0.05). The levels of serum interleukin-1 and interleukin-6 in observation group on the 1st and 2nd postoperative days and levels of serum tumor necrosis factor-α and high-sensitivity C-reactive protein in observation group on the 1st, 2nd and 3rd postoperative days were significantly lower than those in control group; MMSE score at different postoperative time points in observation group was significantly higher than that in control group(all P<0.05). The incidence of postoperative cognitive dysfunction 7 d and 1 month after surgery in the observation group was lower than that in the control group［10.0%(5/50) vs 34.0%(17/50), 6.0%(3/50) vs 18.0%(9/50)］（χ2=8.392, P=0.003; χ2=4.332, P=0.038）. Conclusion Ulinastatin prior-use in elderly patients with RALRP can effectively inhibit the release of systemic inflammatory factors and reduce the incidence of postoperative cognitive dysfunction.