乌司他丁对老年骨科手术患者术后短期认知功能的保护作用

目的探讨乌司他丁对老年患者术后早期认知功能障碍的影响及血清细胞因子差异。方法选取骨科60例择期行髋关节置换老年患者,在全麻下分别接受手术,术前1d及术后1d采用MMSE行认知功能评价。在麻醉诱导前（T1）、拔管前（T2）、术后6h（T3）、术后24h（T4）行血清S-100β浓度测定,术后3天测定血TNF-α、IL-6水平。结果术后24h乌司他丁组MMSE评分较术前降低分值为（-1.23±2.73）分,对照组为（-4.87±3.79）分,两组比较差异有统计学意义（P〈0.05）。对照组T2～T4血清S-100β浓度高于T1,乌司他丁组T3、T4高于T1,乌司他丁组T3、T4血清S-100β浓度升高幅度低于对照组（P〈0.05）。两组术后3天TNF-αI、L-6均高于术前,但乌司他丁组升高幅度远低于对照组（P〈0.05）。结论乌司他丁对老年骨科手术患者术后认知功能具有保护作用,可能与其抑制外周细胞因子释放有关。

Protective effect of Ulinastatin upon short-term postoperative cognitive function in elderly patients after orthopedic surgery

Objective To investigate if ulinastatin will protect the short-term postoperative cognitive function of elderly patients and influence the concentration of serum cytokines.Methods 60 elderly patients with hip replacement surgery were selected and received general anesthesia.Cognitive function was assessed 1 day preoperatively and 1 day postoperatively with MMSE.The concentration of serum S100βprotein was measured before anesthesia（T1）,before extubation（T2）,6 h（T3）,24 h（T4） after surgery.The levels of serum TNF-α,IL-6 were measured 3 days after surgery.Results Compare to 1 day preoperatively,the postoperative MMSE score declined in both groups.In ulinastatin group,the score decreased in some degree,but in the control group was more significant（P〈0.05）.In the T2～4,the concentration of serum S-100βwas higher than T1 after operation in control group.In the ulinastatin group,there was S-100βelevation in T3 and T4.Compare to control group,the concentration of S-100β was lower in any time point when after orthopedic operation.Three day after operation,the levels of serum TNF-α,IL-6 were higher than that before in both groups,but the elevate was more obviously in control group.Conclusion Ulinastatin has a protective effect upon short-term postoperative cognitive function in elderly patients with orthopedic surgery,and the effect may be related to inhibition of peripheral cytokine release.