乌司他丁对双侧全膝关节置换术后患者炎性反应和急慢性疼痛的影响  

The effect of ulinastatin on patients' inflammatory response,acute and chronic pain after bilateral total knee arthroplasty

作　　者：唐帅[1] 徐仲煌[1] 杨宏[2] 任立英[3] 钱文伟[4] 翁习生[4] 黄宇光[1] 

机构地区：[1]北京协和医院麻醉科,北京100730 [2]淮北市人民医院麻醉科,安徽淮北235000 [3]北京协和医院麻醉科急性疼痛服务小组(APS),北京100730 [4]北京协和医院骨科,北京100730

出　　处：《基础医学与临床》2014年第4期514-518,共5页Basic and Clinical Medicine

基　　金：天普研究基金(01201013)

摘　　要：目的观察乌司他丁对充气式止血带下接受双侧全膝关节置换术(TKA)的患者的围术期炎性反应、术后急性疼痛和慢性疼痛、以及膝关节功能康复速度的影响。方法在大腿止血带下接受双侧TKA的患者40例,随机分为对照组(C组)和试验组(U组),U组静脉给予乌司他丁。所有患者全身麻醉、术后镇痛和功能康复方案均相同。在不同时间点用酶联免疫吸附(ELISA)法测定IL-6、TNF-α和IL-10浓度,观察静息和活动时VAS疼痛的评分,阿片类药消耗量,膝关节主动屈膝角度和持续被动运动角度及步行30 m所需时间。结果两组患者的一般情况没有差异。U组的部分时间点的炎性因子水平低于C组(P<0.05)。U组术后4 h的静息疼痛评分和舒芬太尼用量显著低于C组(P<0.05)。术后各时间点的功能康复指标均无差异。结论乌司他丁可以减轻围术期炎性反应,降低术后早期的静息疼痛评分,减少阿片类药物用量。Objective To investigate the effect of ulinastatin （ Urinary Trypsin Inhibitor, UTI） on patients＇ periop- erative inflammatory response, postoperative acute and chronic pain, and the rehabilitation of knee joint after bilat- eral total knee arthroplasty （TKA） under pneumatic tourniquet. Methods 40 patients scheduled for bilateral TKA under thigh tourniquet, were enrolled and randomly assigned to trial group （U group ） and control group （C group）. U group received intravenous ulinastatin and C group received saline at identical time points. All patients received the same general anesthesia, postoperative analgesia and rehabilitation protocols. The plasma concentration of inflammatory cytokines, such as IL-6, TNF-α, and IL-10, were recorded at different time points. The patient＇s VAS at rest and activity, the opioid consumption, the range of active knee flexion and continuous passive motion, andthe time of walking 30 meters were observed and compared. Results L＇~o slgnlncant onlervnt~ groups regarding the demographic data. The inflammatory response of U group was lower than that of C group. The VAS at rest and activity and sufentanil consumption at 4 hours after the surgery of U group were significantly lower than C group. No statistically significant difference was found in postoperative functional rehabilitation parameters at all time points. Conclusions Ulinastatin can alleviate perioperative inflammatory response, decrease early postop- erative resting pain scores and reduce opioid consumption.

关 键 词：全膝关节置换术 乌司他丁 炎性反应 术后急性疼痛 功能康复 

分 类 号：R614.2[医药卫生—麻醉学]