目的 探讨注射用乌司他丁联合盐酸右美托咪定注射液对腹腔镜下老年结直肠癌根治术患者肺功能、认知功能和炎性反应的影响。方法 选择2018年2月-2019年12月南阳市中心医院收治的108例拟行腹腔镜根治手术的老年结直肠癌患者，将患者按照随机数字表法分为右美托咪定组和乌司他丁联合右美托咪定组，每组各54例。右美托咪定组患者麻醉诱导前静脉泵入0.5 μg/kg盐酸右美托咪定注射液，之后以0.3 μg/（kg·h）持续泵入至手术结束前30 min。乌司他汀联合右美托咪定组患者麻醉诱导前静脉泵入0.5μg/kg盐酸右美托咪定注射液和2 kU/kg注射用乌司他丁，之后右美托咪定以0.3 μg/（kg·h）持续静脉泵入至手术结束前30 min，乌司他丁以1 kU/（kg·h）持续静脉泵入至手术结束。观察两组患者术后认知功能、肺功能和炎性因子水平。结果 术后，两组蒙特利尔认知评估（MoCA）评分、简易智能精神状态检查（MMSE）评分均呈降低趋势（P<0.05），并且术后1、3 d，乌司他丁联合右美托咪定组的MoCA评分、MMSE评分均高于同期右美托咪定组（P<0.05）。苏醒后，两组患者第1秒用力呼气容积（FEV1）、FEV1/用力肺活量（FVC）、FEV1占预计值百分数（FEV1% pred）均显著降低（P<0.05），乌司他丁联合右美托咪定组FEV1、FEV1/FVC、FEV1% pred高于右美托咪定组（P<0.05）。两组血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）、C反应蛋白（CRP）水平均先上升后逐渐下降（P<0.05），乌司他丁联合右美托咪定组T₁至T₅基线处血清IL-6、TNF-α、PCT、CRP水平明显低于右美托咪定组（P<0.05）。术后1、3 d，两组患者谵妄发生率均显著降低（P<0.05）；术后1 d，乌司他丁联合右美托咪定组谵妄发生率明显低于右美托咪定组（P<0.05），术后3 d两组谵妄发生率比较无统计学差异。结论 注射用乌司他丁联合盐酸右美托咪定注射液可减少老年结直肠癌腹腔镜手术患者肺功能、认知功能的损伤，降低血清炎性因子水平和术后谵妄的发生。

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

河南省科技发展计划项目（152300410163）