乌司他丁预处理对老年髋部骨折患者术后认知功能的影响  

Effect of ulinastatin on postoperative cognitive function in the elderly with fracture

作　　者：单新[1] 张秀宁[1] 李雪靖[2] 徐贯杰[1] 李志华[1] 

机构地区：[1]河北医科大学第三医院麻醉科,石家庄050051 [2]河北医科大学第三医院药剂科,石家庄050051

出　　处：《中华医学杂志》2015年第20期1586-1589,共4页National Medical Journal of China

基　　金：河北省医学适用技术跟踪项目（GL201341）

摘　　要：目的 对老年髋部骨折患者术前预防性应用乌司他丁,观察其术后认知功能及C反应蛋白（CRP）的变化.方法 随机数字表法将48例65岁以上髋部骨折患者随机分为2组：乌司他丁组（21例）与对照组（27例）.所有患者均行腰硬联合阻滞麻醉.乌司他丁组在切皮前和手术结束即刻分别给予乌司他丁5 000 U/kg缓慢静脉点滴.分别于术日（T0）、术后第1天（T1）、术后第3天（T2）、术后第7天（T3）清晨对患者进行简易智能状态量表评分（MMSE）,计算各组认知功能障碍（POCD）发生率.于T0及T2时点抽取静脉血,测定血浆CRP浓度.结果 T1及T2时点乌司他丁组MMSE评分为（26.0±0.7）和（26.6±0.6）,高于对照组的（23.8±0.8）和（24.3±0.7）,差异有统计学意义（￡1=2.161,t2=2.431,P＜0.05）,T0及T3时2组MMSE评分分别为（26.9±0.5）、（26.7±0.6）分和（26.5±0.5）、（25.2±0.7）分,差异无统计学意义（t0=0.472,t3=1.585,P＞0.05）.患者术后POCD总发生率分别为4.8％和40.7％,乌司他丁组低于对照组（χ^2=8.155,P＜0.01）.乌司他丁组术后CRP为（64.46±9.86）mg/L,低于对照组的（123.63±7.17） mg/L,差异有统计学意义（t=-4.974,P＜0.05）.结论 乌司他丁预处理可明显降低老年髋部骨折患者POCD的发生率,可能与其抗炎作用有关.Objective To observe the vary of postoperation cognitive function and inflammatory mediators CRP in elderly patients with fracture after using ulinastatin.Methods Forty-eight patients over 65 years old patients with hip fracture were randomly divided into two groups：ulinastatin group（n =21）and control group （n =27）.All patients underwent combined spinal-epidural anesthesia.The patients in ulinastatin group received intravenous injection of ulinastatin with a dose of 5 000 U/kg before skin incision and at the moment of the end of operation.Cognitive function was assessed by Mini-Mental State Examination （MMSE）at the day of the operation（T0）,1 （T1）,3 （T2）and 7 （T3） days after opreation.The incidence of POCD was calculated.Blood samples were taken at the day of the operation and 3 days after operation for determination of CRP.Results Compared with control group （23.8 ± 0.8,24.3 ± 0.7）,the MMSE scores were significantly increased at T1,T2 in ulinastatin group （26.0 ± 0.7,26.6 ± 0.6） （t1 =2.161,t2 =2.431,P 〈 0.05）.There were no differences at T0,T3 （t0 =0.472,t3 =1.585,P 〉 0.05）.The respectively incidence of POCD of ulinastatin group and control group were 40.7% and 4.8%,and that of ulinastatin group was significantly lower than control group （χ^2 =8.155,P 〈 0.01）.Serum CRP concentration of ulinastatin group after operation was （64.46 ± 9.86） mg/L,significantly lower than control group （123.63 ± 7.17） mg/L （t =-4.974,P 〈 0.05）.Conclusion Ulinastatin can reduce the incidence of POCD in the elderly patients with fracture,which may be related to the anti-inflammatory effect of ulinastatin.

关 键 词：乌司他丁 术后认知功能障碍 简易智能状态量表 C反应蛋白 

分 类 号：R614[医药卫生—麻醉学]