| 乌司他丁对老年髋关节置换患者术后认知功能障碍的影响 |
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Received:March 28, 2010
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| 作者 | Author | 单位 | Unit | E-Mail |
| 康亚梅 |
KANG Ya-mei |
宁波市第六医院麻醉科,浙江 宁波 315040 |
Department of Anesthesia,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
geyeying59198@163.com |
| 葛叶盈 |
GE Ye-ying |
宁波市第六医院麻醉科,浙江 宁波 315040 |
Department of Anesthesia,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 成建庆 |
CHENG Jian-qing |
宁波市第六医院麻醉科,浙江 宁波 315040 |
Department of Anesthesia,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 陈跃波 |
CHEN Yue-bo |
宁波市第六医院麻醉科,浙江 宁波 315040 |
Department of Anesthesia,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 袁娜 |
YUAN Na |
宁波市第六医院麻醉科,浙江 宁波 315040 |
Department of Anesthesia,Ningbo 6th Hospital,Ningbo 315040,Zhejiang,China |
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| 赵刘军 |
ZHAO Liu-jun |
宁波市第六医院骨科 |
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| 徐荣明 |
XU Rong-ming |
宁波市第六医院骨科 |
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| 期刊信息：《中国骨伤》2010年23卷，第5期，第355-357页 |
| DOI：10.3969/j.issn.1003-0034.2010.05.012 |
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目的：评价乌司他丁对老年髋关节置换术患者术后认知功能障碍的影响。
方法：择期行髋关节置换术的老年患者80例，年龄≥65岁，ASAⅠ或Ⅱ级，随机分为两组，对照组和乌司他丁组，每组40例。乌司他丁组男21例，女19例，平均年龄(75.00±7.81)岁，体重(58.20±11.21) kg,在手术切皮前(1万 U/kg)、术后第l、2、3 天 5 000 U/kg 缓慢静脉注射乌司他丁；对照组男20例，女20例，平均年龄(72.80±7.25)岁，体重(55.60±7.50) kg,只给予等量生理盐水。术前1 d和术后3 d用简易智能状态检查法(MMSE)进行认知功能测试，以术后MMSE评分下降大于或等于术前1个标准差评定为术后认知障碍。于术前(To)、术毕(T1)、术后3 h(T2)、1 d(T3)、 3 d(T4)测定血清S100β蛋白含量。
结果：对照组 10例发生认知障碍(25%),乌司他丁组 1例发生(2.5%),较对照组降低(P<0.05).对照组手术前后MMSE评分分别为(25.2±2.1)、(22.6±2.5)分，T0～4 时S100β蛋白浓度分别为(0.041±0.012)、(0.125±0.031)、(0.178±0.036)、(0.142±0.038)、(0.048±0.015) μg/L;乌司他丁组手术前后MMSE评分分别为(25.9±2.4)、(24.8±2.1)分，T0～4 时S100蛋白浓度分别为(0.040±0.013)、(0.095±0.021)、(0.116±0.017)(0.087±0.019)、(0.043±0.012) μg/L.与术前比较，对照组术后3 d MMSE评分降低(P<0.05),T1～3时S100β蛋白浓度升高(P<0.05);与对照组比较，乌司他丁组术后3 d MMSE评分增加(P<0.05),T1～时S100β蛋白浓度降低(P<0.05 ).
结论：老年髋关节置换术患者围术期应用乌司他丁，能一定程度的预防患者术后认知障碍的发生。 |
| [关键词]:胰蛋白酶抑制剂 手术后并发症 认知障碍 关节成形术,置换,髋 |
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| Effect of ulinastatin on post-operative cognition disorders in elderly patients undergoing hip joint replacement |
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Abstract:
Objective: To evaluate the effect of ulinastatin on post-operative Cognition disorders in elderly patients undergoing hip joint replacement.
Methods: Fourty ASAⅠorⅡelderly patients undergoing selective hip joint replacement,aged≥65 years,were randomly divided into 2 groups(n=40 each):control group and ulinastatin group. Ulinastatin group received iv infusion of ulinastatin(10 000 u/kg) after skin incision,(5 000 U/kg ) after operation 1,2,3 d respectively,included 21 males and 19 females with an average age of(75.00±7.81)years old. Control group received the same volume of normal saline instead of ulinastatin,included 20 males and 20 females with an average age of (72.80±7.25) years old. Neuroeognitive testing was performed on the preoperative day and on the 3th postoperative day and post-operative cognition disorders was defined as 1 SD decline from baseline on neuroeognirive assessment. Serum S100β protein were measured before operation,at the end of surgery,3,24 h and 3 d after operation.
Results: The incidence rate of postoperative cognition disorders was 2.5% in ulinastatin group,there were lower than those of patients in the control group(25%) (P<0.05);In control group,the scales for MMSE before and after operation were(25.2±2.1),(22.6±2.5) scores and the level of serum S100β protein at T0-4 were(0.041±0.012),(0.125±0.031),(0.178±0.036),(0.142±0.038),(0.048±0.015) μg/L. As well in ulinastatin group,above date were(25.9±2.4),(24.8±2.1),(0.040±0.013),(0.095±0.021),(0.116±0.017),(0.087±0.019) and(0.043±0.012) respectively. Compared with preoperative,MMSE evaluation scale was decreased on the 3th postoperative day and the S100β was increased markedly at T1-3 in control group(P<0.05);Compared with control group,MMSE evaluation scale was increased and the S100β was decreased markedly at T1-3 in ulinastatin group(P<0.05 ).
Conclusion: Intravenous infusion of ulinastatin during operation can prevent the occurrence of POCD in elderly patients. |
| KEYWORDS:Trypsin inhibitors Postoperative complications Cognition disorders Arthroplasty,replacement,hip |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 康亚梅,葛叶盈,成建庆,陈跃波,袁娜,赵刘军,徐荣明.乌司他丁对老年髋关节置换患者术后认知功能障碍的影响[J].中国骨伤,2010,23(5):355~357 |
| 英文格式: | KANG Ya-mei,GE Ye-ying,CHENG Jian-qing,CHEN Yue-bo,YUAN Na,ZHAO Liu-jun,XU Rong-ming.Effect of ulinastatin on post-operative cognition disorders in elderly patients undergoing hip joint replacement[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(5):355~357 |
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