本文選題：右美托咪定 + 烏司他丁　； 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：術(shù)后認(rèn)知功能障礙(Postoperative Cognitive Dysfunction, POCD)是指患者術(shù)后出現(xiàn)中樞神經(jīng)系統(tǒng)并發(fā)癥,主要表現(xiàn)為術(shù)后出現(xiàn)定向力、記憶力、注意力、語言理解力等中樞神經(jīng)功能改變。 POCD患者精神和人格的改變,會(huì)導(dǎo)致術(shù)后社交能力及認(rèn)知能力等改變,康復(fù)延遲,增加患者住院醫(yī)療總費(fèi)用,影響術(shù)后生活質(zhì)量,甚至?xí)M(jìn)展成為永久性認(rèn)知障礙,失去生活自理能力,進(jìn)而影響到患者的社會(huì)活動(dòng)以及工作。造成嚴(yán)重后果。據(jù)文獻(xiàn)報(bào)道,60歲以上的非心臟手術(shù)老年患者,術(shù)后早期POCD的發(fā)生率高達(dá)3%～61%。 導(dǎo)致POCD的因素很多,但尚缺乏明確和統(tǒng)一的金標(biāo)準(zhǔn)。到目前為止,比較公認(rèn)的高危因素為高齡及比較嚴(yán)重的外科創(chuàng)傷。既往研究表明,手術(shù)創(chuàng)傷、術(shù)后疼痛及機(jī)體應(yīng)激引起全身炎性反應(yīng)綜合征及不同類型細(xì)胞因子釋放,在患者POCD的發(fā)生中起到至關(guān)重要的作用。隨著微創(chuàng)技術(shù)的進(jìn)步,腹腔鏡下直結(jié)腸癌手術(shù)已成為臨床中較為常見的手術(shù)。研究發(fā)現(xiàn),腔鏡手術(shù)患者術(shù)中C02氣腹后,會(huì)導(dǎo)致腦組織代謝存在不同程度的障礙,術(shù)中大腦氧合情況的變化,加上氣腹造成不同程度的神經(jīng)損傷,使血漿S100β蛋白和NSE濃度有所增高,可能會(huì)誘發(fā)POCD。開腹手術(shù)組患者相比,腹腔鏡手術(shù)組患者術(shù)后認(rèn)知功能評(píng)分的下降幅度較小,可能是由于腹腔鏡手術(shù)創(chuàng)傷相對(duì)小,手術(shù)及麻醉時(shí)間較短,對(duì)患者神經(jīng)功能影響也較小,所以術(shù)后認(rèn)知功能評(píng)分優(yōu)于開腹組。但目前研究缺乏足夠證據(jù)證明腹腔鏡手術(shù)是否能夠降低老年患者POCD的發(fā)生率。 麻醉方式的選擇對(duì)POCD的影響存在爭議。研究發(fā)現(xiàn)：全麻藥物通過影響機(jī)體神經(jīng)突觸的可塑性,導(dǎo)致記憶受損,進(jìn)而改變或損害大腦而引起POCD。 老齡化社會(huì)的到來,POCD引發(fā)的各種醫(yī)學(xué)以及社會(huì)問題正越來越受到醫(yī)學(xué)界的重視。如何降低老年患者圍術(shù)期POCD的發(fā)生率,改善其晚年的生活質(zhì)量尤為重要。 鹽酸右美托咪定(dexmedetomidine,Dex)是一種特異性α2-腎上腺素能受體激動(dòng)劑,具有鎮(zhèn)靜、睡眠、抗焦慮等效應(yīng),在產(chǎn)生抗交感及抗寒戰(zhàn)等作用的同時(shí),還具有一定的鎮(zhèn)痛作用,用于手術(shù)中輔助麻醉,對(duì)中樞神經(jīng)有保護(hù)作用,并能改善患者術(shù)后認(rèn)知功能。 研究證明,Dex具有不同程度的神經(jīng)保護(hù)作用。也有研究發(fā)現(xiàn)Dex應(yīng)用于傳統(tǒng)開腹手術(shù)結(jié)直腸癌手術(shù)老年患者中,能降低其POCD發(fā)生率。但Dex對(duì)腹腔鏡下結(jié)直腸癌手術(shù)老年患者POCD的影響,還缺少相關(guān)研究報(bào)道。 烏司他丁(ulinastatin, urinary trypsin inhibitor。UTI)是一種從我們?nèi)梭w的尿液中進(jìn)行分離純化出來的藥物,具有較為廣譜的酶的抑制作用而被廣泛使用。 研究證明,烏司他丁能夠?qū)C(jī)體的炎癥反應(yīng)產(chǎn)生抑制,通過減少機(jī)體神經(jīng)細(xì)胞的凋亡,從而對(duì)機(jī)體的學(xué)習(xí)記憶功能障礙產(chǎn)生改善作用,因而降低老年患者POCD的發(fā)生率。 研究發(fā)現(xiàn),單獨(dú)應(yīng)用烏司他丁或地塞米松,對(duì)內(nèi)毒素所致的兔肺損傷,均有不同程度的保護(hù)作用,聯(lián)合應(yīng)用烏司他丁與地塞米松可能強(qiáng)化此作用,從而起到更好效果。而烏司他丁復(fù)合其他藥物對(duì)降低老年患者的POCD發(fā)生率的影響,目前國內(nèi)外還缺少相關(guān)研究報(bào)道。 綜上所述,由于麻醉藥本身對(duì)POCD發(fā)病影響尚存爭議,POCD發(fā)病機(jī)制尚不明確,臨床研究工作中的倫理問題、研究方法、診斷標(biāo)準(zhǔn)并未統(tǒng)一、主觀性較強(qiáng)等問題,造成報(bào)道的結(jié)論并不一致。本研究借鑒國際POCD研究小組的研究方案,通過建立空白對(duì)照組,從而達(dá)到判斷患者術(shù)后認(rèn)知功能變化是否為正常變異的目的,使POCD診斷方法較為合理。 研究表明,烏司他丁與鹽酸右美托咪啶均可一定程度減少應(yīng)激反應(yīng),減少炎癥介質(zhì)等對(duì)手術(shù)患者臟器的損傷,從而降低老年患者POCD的發(fā)生率。但是,兩者聯(lián)合應(yīng)用是否具有協(xié)同或強(qiáng)化作用,從而進(jìn)一步降低患者術(shù)后POCD的發(fā)生率,起到更好的臟器保護(hù)目的鮮見報(bào)道。因此,本研究探討在相同麻醉深度,根據(jù)患者術(shù)后第1天和術(shù)后第3天MMSE的神經(jīng)精神測試結(jié)果,評(píng)估并比較單獨(dú)應(yīng)用鹽酸右美托咪啶或?yàn)跛舅?及兩者聯(lián)合應(yīng)用對(duì)腹腔鏡下直結(jié)腸癌手術(shù)老年患者POCD的影響,為預(yù)防老年患者POCD的發(fā)生提供新思路和方法,進(jìn)而改善老年患者晚年的生活質(zhì)量。 方法選取擇期全麻下行腹腔鏡下結(jié)直腸癌手術(shù)老年患者80例為研究對(duì)象,患者ASA Ⅰ～Ⅱ級(jí),年齡65歲以上。隨機(jī)數(shù)字表法分為0.9%氯化鈉注射液空白對(duì)照組(A組),鹽酸右美托咪定組(D組),烏司他丁組(U組),鹽酸右美托咪定+烏司他丁組(D+U組),每組20例。四組患者一般資料差異無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性�；颊哌M(jìn)入手術(shù)室前均不給予術(shù)前用藥。所有患者均采用全憑靜脈麻醉。其中D組在麻醉誘導(dǎo)前15min采用微量輸注泵在15mmin內(nèi)輸注0.5μg/kg鹽酸右美托咪定預(yù)注負(fù)荷劑量,后以0.3μg/kg/h的速度持續(xù)泵注(生理鹽水將鹽酸右美托咪定配制成4μg/mL),手術(shù)結(jié)束前30min停止輸注；U組在相同時(shí)點(diǎn)予2ku/kg烏司他丁,隨后以1ku/(kg·h)泵注至術(shù)畢；D+U組按上述兩種方法同時(shí)給予鹽酸右美托咪定和烏司他丁持續(xù)泵注；A組于相同時(shí)點(diǎn)予等量0.9%氯化鈉注射液持續(xù)泵注。麻醉誘導(dǎo)：靜脈注射咪達(dá)唑侖0.02～0.04mg/kg,依托咪酯0.1～0.3mg/kg,枸櫞酸舒芬太尼0.2～0.3μg/kg,維庫溴銨0.1mg/kg,氣管插管后接麻醉機(jī)行機(jī)械通氣。麻醉維持采用丙泊酚和瑞芬太尼全憑靜脈維持麻醉,采用微量輸注泵持續(xù)泵入瑞芬太尼0.05～0.2μ g/kg/min,并根據(jù)手術(shù)情況間斷追加枸櫞酸舒芬太尼及維庫溴銨。術(shù)中保持血壓波動(dòng)在基礎(chǔ)值的10%以內(nèi),維持術(shù)中血氧飽和度(SP02)98%。維持NI值在D1-E1級(jí),NI目標(biāo)值在45～55間。手術(shù)結(jié)束前半小時(shí)給予舒芬太尼5-10μ g,氟比洛芬脂50mg進(jìn)行超前鎮(zhèn)痛�；颊咝g(shù)畢不給予拮抗肌松,待患者恢復(fù)自主呼吸,潮氣量6mL/kg,呼吸頻率30次/min, PETCO2維持35～45mmHg,患者呼之能睜眼,握拳有力時(shí)拔除氣管導(dǎo)管。術(shù)后給予經(jīng)靜脈自控鎮(zhèn)痛(PCIA),藥物配方為舒芬太尼1.5～2.0μg/kg,氟比洛芬脂1.5～2.0mg/kg,雷莫司瓊3mg,用生理鹽水稀釋至150m1,背景輸注速率為3ml/h,自控鎮(zhèn)痛(PCA)量為3m1,鎖定時(shí)間15mim,維持患者術(shù)后VAS評(píng)分≤3分。 觀察指標(biāo)術(shù)中常規(guī)監(jiān)測血壓、心電圖、SP02,記錄術(shù)中出血量、膠體及晶體輸液量、尿量、手術(shù)時(shí)間、恢復(fù)自主呼吸時(shí)間(從術(shù)畢到患者恢復(fù)自主呼吸)、睜眼時(shí)間(從患者恢復(fù)自主呼吸到睜眼時(shí)間)、拔除氣管導(dǎo)管時(shí)間(從患者睜眼到拔除氣管導(dǎo)管時(shí)間)；記錄術(shù)中使用舒芬太尼,瑞芬太尼,維庫溴銨,丙泊酚的用量情況；記錄恢復(fù)期不良反應(yīng),包括高血壓、心動(dòng)過速、躁動(dòng)、惡心、嘔吐發(fā)生率的發(fā)生情況。觀察術(shù)后傷口疼痛情況,并行VAS評(píng)分。分別在手術(shù)前1天和手術(shù)后第1天和術(shù)后第3天進(jìn)行簡易智力狀態(tài)檢查法(MMSE)的神經(jīng)精神測試。如果術(shù)后得分對(duì)比術(shù)前基礎(chǔ)值降低≥2分,認(rèn)為發(fā)生POCD。計(jì)算出手術(shù)后患者第1天和術(shù)后第3天的POCD的發(fā)生率。 統(tǒng)計(jì)學(xué)處理研究數(shù)據(jù)采用SPSS13.0統(tǒng)計(jì)學(xué)軟件進(jìn)行處理。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,組間比較采用單因素方差分析,計(jì)數(shù)資料采用x2檢驗(yàn)。P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果1)一般情況和術(shù)中液體出入量、手術(shù)時(shí)間、恢復(fù)自主呼吸時(shí)間、拔除氣管導(dǎo)管時(shí)間,以及術(shù)中使用舒芬太尼、瑞芬太尼、維庫溴銨的總量比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)；與對(duì)照組、烏司他丁組比較,鹽酸右美托咪定組和鹽酸右美托咪定+烏司他丁組睜眼時(shí)間延長,術(shù)中使用丙泊酚的量明顯減少,恢復(fù)期高血壓、心動(dòng)過速、躁動(dòng)、惡心、嘔吐發(fā)生率均下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 2)術(shù)前MMSE評(píng)分組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)；對(duì)照組術(shù)后第1天和術(shù)后第3天的MMSE評(píng)分均明顯下降,與術(shù)前MMSE評(píng)分相比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；鹽酸右美托咪定組、烏司他丁組和鹽酸右美托咪定+烏司他丁組患者術(shù)后第1天和術(shù)后第3天的MMSE評(píng)分均無明顯下降,與術(shù)前MMSE評(píng)分相比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 3)對(duì)照組患者術(shù)后第一天和第三天POCD的發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)；與對(duì)照組比較,鹽酸右美托咪定組、烏司他丁組和鹽酸右美托咪定+烏司他丁組患者術(shù)后認(rèn)知功能障礙的發(fā)生率均明顯下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；與鹽酸右美托咪定組、烏司他丁組比較,鹽酸右美托咪定+烏司他丁組患者術(shù)后認(rèn)知功能障礙的發(fā)生率無明顯進(jìn)一步下降,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論1)麻醉誘導(dǎo)前給予鹽酸右美托咪啶0.5μg/kg,術(shù)中以0.3μg/kg/h的輸注速率輸注能使腹腔鏡下結(jié)直腸癌手術(shù)老年患者術(shù)后早期認(rèn)知功能障礙的發(fā)生率下降,并減少患者恢復(fù)期不良反應(yīng)。 2)麻醉誘導(dǎo)前給予烏司他丁2ku/kg,術(shù)中以1ku/(kg·h)的輸注速率輸注能降低腹腔鏡下結(jié)直腸癌手術(shù)老年患者術(shù)后早期認(rèn)知功能障礙的發(fā)生率。 3)與單獨(dú)應(yīng)用鹽酸右美托咪啶或?yàn)跛舅∠啾?聯(lián)合應(yīng)用鹽酸右美托咪啶與烏司他丁,并不能進(jìn)一步降低腹腔鏡下結(jié)直腸癌手術(shù)老年患者術(shù)后早期認(rèn)知功能障礙的發(fā)生率。
[Abstract]:Postoperative cognitive dysfunction (Postoperative Cognitive Dysfunction, POCD) refers to the postoperative complications of the central nervous system, mainly manifested in the changes of central nervous function, such as orientation, memory, attention, and language comprehension.
Changes in the spirit and personality of POCD patients will lead to changes in social and cognitive abilities after operation, delay in rehabilitation, increase the total cost of hospitalization, affect the quality of life, even become permanent cognitive impairment, lose the ability to take care of life, and then affect the social activities and work of the patient. It is reported that the incidence of POCD in the elderly patients over 60 years old is 3% to 61%. after operation.
There are many factors leading to POCD, but there is still a lack of clear and unified gold standards. Up to now, the relatively recognized high risk factors are older and more severe surgical trauma. Previous studies have shown that surgical trauma, postoperative pain and body stress cause systemic inflammatory response syndrome and different types of cytokines release, and the occurrence of POCD in patients. With the progress of minimally invasive technique, laparoscopic colon cancer surgery has become a more common operation in the clinic. It is found that the C02 pneumoperitoneum in patients undergoing endoscopic surgery can lead to different degrees of disturbance in the brain tissue metabolism, changes in cerebral oxygenation in the operation, and the effects of pneumoperitoneum on different degrees. Nerve injury, which makes the plasma S100 beta protein and the concentration of NSE increase, may induce the decrease in the cognitive function score of the patients in the laparotomy group and the laparoscopic operation group, which may be due to the relatively small trauma of the laparoscopic operation, the shorter operation and the anesthesia time, and the less influence on the patient's nerve function. The posterior cognitive function score is better than the laparotomy group. However, there is insufficient evidence to prove that laparoscopic surgery can reduce the incidence of POCD in elderly patients.
The effect of the selection of anesthetic methods on POCD is controversial. The study found that general anesthesia drugs can cause impairment of memory by affecting the plasticity of the body's synapses, and then change or damage the brain and cause POCD..
With the advent of the aging society, various medical and social problems caused by POCD are being paid more and more attention by the medical community. It is particularly important to reduce the incidence of POCD in the perioperative period of the elderly and improve the quality of life in his later years.
Dexmedetomidine (Dex) is a specific alpha 2- adrenergic receptor agonist, which has sedative, sleep and anti anxiety effects. It also has a certain analgesic effect while producing anti sympathetic and anti cold action. It can be used to assist anesthesia during operation, protect the central nervous system and improve the postoperative patients' operation. Cognitive function.
Studies have shown that Dex has different degrees of neuroprotective effect. There are also studies found that Dex can reduce the incidence of POCD in elderly patients with colorectal cancer surgery, but the impact of Dex on POCD in elderly patients with colorectal cancer surgery is still lack of relevant research reports.
Ulinastatin (urinary trypsin inhibitor.UTI) is a drug that is isolated and purified from the urine of our human body and is widely used in the inhibition of broad-spectrum enzymes.
Studies have shown that Ulinastatin can inhibit the inflammatory response of the body and reduce the body's learning and memory dysfunction by reducing the apoptosis of the body's nerve cells, thus reducing the incidence of POCD in the elderly patients.
The study found that Ulinastatin or dexamethasone have different protective effects on endotoxin induced lung injury in rabbits. Combined use of ulinastatin and dexamethasone may enhance the effect, and the effect of ulinastatin combined with other drugs on the incidence of POCD in elderly patients is currently in the country. There is also a lack of relevant research reports.
In summary, because the effect of the anesthetic on the incidence of POCD remains controversial, the pathogenesis of POCD is not clear, the ethical problems in the clinical research work, the research methods, the diagnostic criteria are not unified, the subjectivity is strong and so on, and the results of the report are not consistent. This study borrows from the research program of the international POCD research group and through the establishment of the empty space. White control group, so as to determine whether the postoperative cognitive function changes are normal changes, so that the POCD diagnosis method is more reasonable.
Studies have shown that Ulinastatin and dexmeimidine hydrochloride can reduce the stress response to a certain extent, reduce the damage of the inflammatory mediators to the viscera of the patients and reduce the incidence of POCD in the elderly patients. However, the combination of the two combinations has a synergistic or enhanced effect to further reduce the incidence of postoperative POCD in patients. Good viscera protection is rarely reported. Therefore, this study was to evaluate and compare the effects of right metoimidine or ulinastatin on the same anesthetic depth at the first day after first days and third days after the operation, and the combination of them on POCD in elderly patients with colon cancer surgery under abdominal endoscopy. To provide new ideas and methods to prevent the occurrence of POCD in elderly patients, and to improve the quality of life of elderly patients in their later years.
Methods 80 elderly patients with laparoscopic colorectal cancer surgery under general anesthesia were selected as the subjects. The patients were ASA I to grade II, aged over 65 years. The random digital table method was divided into 0.9% Sodium Chloride Injection blank control group (group A), right metoimidin group (group D), ulinastatin group (Group U), right metomomidin + Ulinastatin group (group D+U). There were 20 cases in each group. There was no statistical difference in the general data of the four groups (P0.05), which was comparable. All patients were not given preoperative medication before entering the operation room. All patients were treated with total intravenous anesthesia. In group D, before induction of anesthesia, 15min was injected into the 15mmin infusion of 0.5 mu g/kg dexmeimidin. At the speed of 0.3 mu g/kg/h (normal saline was prepared by right metomomidine hydrochloride to 4 g/mL), 30min stopped infusion before the end of the operation; group U was given 2ku/kg Ulinastatin at the same time, followed by 1ku/ (kg h) pump, and the D+U group was given a continuous infusion of right metomomidin and Ulinastatin by these two methods; A group 0.9% Sodium Chloride Injection continuous pumps were given at the same time. Anesthesia induction: intravenous midazolam 0.02 ~ 0.04mg/kg, etomidate 0.1 ~ 0.3mg/kg, sufentanil citrate 0.2 ~ 0.3 u g/kg, vecuronium 0.1mg/kg, endotracheal intubation machine for mechanical ventilation. Anesthesia was maintained by propofol and remifentanil by intravenous Maintenance anesthesia, using a microinfusion pump continuously pumped into remifentanil 0.05 ~ 0.2 g/kg/min, and adding sufentanil and vecuronium citrate intermittently according to the operation conditions. During the operation, the blood pressure fluctuated within 10% of the basic value. The maintenance of blood oxygen saturation (SP02) 98%. maintained NI value at D1-E1, NI target value at 45~55. After half an hour, sufentanil was given 5-10 mu g and flurbiprofen 50mg for preemptive analgesia. The patients did not give antagonistic muscle relaxants, the patients recovered their spontaneous breathing, the moisture content was 6mL/kg, the respiratory rate was 30 times /min, the PETCO2 was maintained 35 to 45mmHg, the patients were able to open their eyes, and the tracheal catheter was removed when the fist was forceful. The patients were given intravenous self-control analgesia (PCIA) after the operation. The formula was sufentanil 1.5 ~ 2 mu g/kg, flurbiprofen fat 1.5 ~ 2.0mg/kg, Lei Mo Si Qiong 3mg, diluted to 150m1 with saline, background infusion rate 3ml/h, 3M1 for controlled analgesia (PCA), locking time 15mim, and maintaining patients' postoperative VAS score less than 3 points.
Routine monitoring of blood pressure, electrocardiogram, SP02, recorded intraoperative bleeding, colloid and crystal infusion volume, urine volume, operation time, recovery of spontaneous breathing time (from the surgery to the patient's spontaneous breathing), open eye time (recovering from the patient to the eye opening time from the patient), and pulling out the tracheal catheter time (from the patient's open eyes to the extraction of the trachea from the patient). Guan Shijian); records the use of sufentanil, remifentanil, vecuronium, and propofol; records the occurrence of adverse reactions in the recovery period, including the incidence of hypertension, tachycardia, agitation, nausea and vomiting. Observation of postoperative wound pain and VAS score. 1 days before the operation and first days after the operation and after the operation, respectively. The neuropsychiatric test of the simple intelligence state examination (MMSE) was performed on the 3 day. If the baseline score was reduced more than 2 points before the operation, the incidence of POCD after first days after the operation and third days after the operation was calculated by POCD..
The statistics processing data were processed with SPSS13.0 statistics software. The measurement data were expressed by mean mean standard deviation (x + s). The single factor variance analysis was used in the group, and the count data using the x2 test.P0.05 was statistically significant.
Results 1) the general situation and the amount of liquid in the operation, the time of operation, the recovery of the time of spontaneous breathing, the time of removal of the tracheal tube, and the total comparison of sufentanil, remifentanil and vecuronium (P0.05), compared with the control group, the right metomomidin group and right metomomidine hydrochloride + The opening time of the Ulinastatin group was prolonged, the amount of propofol used in the operation decreased significantly, and the incidence of hypertension, tachycardia, agitation, nausea and vomiting decreased in the recovery period, and the difference was statistically significant (P0.05).
2) there was no significant difference between the MMSE scores before operation (P0.05); the MMSE scores of the control group first days after the operation and the third day after the operation were significantly decreased, compared with the preoperative MMSE score, the difference was statistically significant (P0.05); the right metoamidine group, the Ulinastatin group and the right metomomidin + Ulinastatin group were performed first days after operation and operation. There was no significant decrease in MMSE scores on the third day after operation, and there was no significant difference compared with preoperative MMSE score (P0.05).
3) there was no significant difference in the incidence of POCD in the first and third days after operation in the control group (P0.05). Compared with the control group, the incidence of postoperative cognitive impairment in right metoimidin group, ulinastatin group and right metomomidin + Ulinastatin group were significantly decreased (P0.05); There was no significant reduction in the incidence of cognitive impairment in the patients with dexmetamidine group and ulinastatin group. There was no significant difference in the incidence of postoperative cognitive impairment in the patients with dexmedetomidin + ulinastatin (P0.05).
Conclusion 1) right metodetidine hydrochloride was given 0.5 g/kg before induction of anesthesia, and the infusion rate of 0.3 mu g/kg/h during the operation could reduce the incidence of early cognitive impairment in the elderly patients with colorectal cancer surgery and reduce the adverse reaction in the recovery period of the patients.
2) ulinastatin 2ku/kg was given before anesthesia induction, and the infusion rate of 1ku/ (kg. H) during the operation could reduce the incidence of early cognitive impairment in elderly patients with laparoscopic colorectal cancer surgery.
3) in comparison with dexmeimidine or Ulinastatin, a combination of right metoimidine and ulinastatin, the incidence of early cognitive impairment in elderly patients with colorectal cancer surgery could not be further reduced.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.34

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本文編號(hào)：1995932