围术期静注乌司他丁降低老年髋关节置换患者术后早期认知功能效果观察

目的：探讨围手术期静注乌司他丁降低老年人髋关节置换患者术后早期认知功能障碍（POCD）的效果。方法将择期行人工全髋关节置换的老年患者60例随机分为乌司他丁组（U 组，n ＝30）和对照组（C 组，n＝30）。两组麻醉方法相同，U 组于麻醉诱导前及术后第1～3天将乌司他丁溶于100 mL 生理盐水中静滴，20～30 min内静滴完毕，C 组给予相同容量生理盐水静滴。分别于术前1天（T0）和术后第1天（T1）、第3天（T2）抽取静脉血，测定血浆中 TNF-α、IL-6浓度。采用简易精神状态量表（MMSE）对两组在术前1天及术后第1天行认知功能评分，评价患者 POCD 的发生情况。结果U 组 T1血浆 IL-6、TNF-α水平较 T0明显升高（P ＜0．05），T2基本达到 T0水平，且 T1、T2血浆 TNF-α、IL-6水平升高幅度明显低于 C 组（P ＜0．05）；C 组 T1、T2血浆 TNF-α、IL-6水平较 T0均明显升高（P ＜0．05）；U 组术后 POCD 发生率为6．7％，显著低于 C 组（16．7％，P ＜0．05）；C 组MMSE 评分较术前显著下降（P ＜0．05），而 U 组术前术后 MMSE 评分比较差异无统计学意义（P ＞0．05）；术后MMSE 评分与血浆 TNF-α、IL-6浓度呈显著正相关（r ＝0．527、0．453，P ＜0．01）。结论乌司他丁能抑制老年人髋关节术后 TNF-α、IL-6等炎性细胞因子的释放，降低 POCD 的发生率。

Observation of curative effect on ulinastatin in short-term postoperative cognitive disfunction after elderly patients undergoing hip joint replacement

Objective To explore the preventive effects of ulinastatin on postoperative cognitive dysfunction in elderly patients undergoing hip joint replacement.Methods Sixty elderly patients undergoing elective artificial hip joint replacement were randomly divided into ulinastatin group （group U,n =30）and control group （group C,n =30）.Both groups received the same anesthesia method.The patients in Group U re-ceived intravenous injection of ulinastatin dissolved in 100 mL saline before general anesthesia induction, and 1~3 days after operation respectively.The patients in Group C received the same volume of normal sa-line instead of ulinastatin.Blood samples were taken to determine the TNF-α,IL-6 at preoperative,1 or 3 days after operation.Postoperative cognitive dysfunction （POCD）was also examined through mini mental state examination on the postoperative 1 day respectively.Results Compared with the preoperative,the plasma levels of TNF-α,IL-6 in group U increased markedly at T1 （P ＆lt;0.05）,which reached the T0 level＆amp;nbsp;at T2 .Compared with group C,the values of TNF-α,IL-6 were significantly low at T1 and T2 （P ＆lt;0.05）. In Group C,the plasma levels of TNF-α,IL-6 significantly elevated compared with T0 （P ＆lt; 0.05）;The incidence rate of POCD was 9.8% in group U,which was lower than that of patients in the group C 19.6%. Control group MMSE score declined significantly compared with preoperative （P ＆lt;0.05）;MMSE score comparison showed no statistical significance at preoperative and preoperative in the group U （P ＆gt;0.05）;The MMSE score and the level of TNF-α,IL-6 had significantly positive correlation （r =0.503,0.461,P＆lt;0.01）.Conclusion Ulinastatin can inhibit the release of inflammatory cytokines TNF-α,IL-6 and reduce the incidence of POCD in the elderly hip surgery.