中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
20期
1586-1589
,共4页
单新%张秀宁%李雪靖%徐贯杰%李志华
單新%張秀寧%李雪靖%徐貫傑%李誌華
단신%장수저%리설정%서관걸%리지화
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
烏司他丁%術後認知功能障礙%簡易智能狀態量錶%C反應蛋白
오사타정%술후인지공능장애%간역지능상태량표%C반응단백
Ulinastatin%Postoperative cognitive dysfunction%Minimum mental state examination%C reactive protein
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(x2=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.
目的 對老年髖部骨摺患者術前預防性應用烏司他丁,觀察其術後認知功能及C反應蛋白(CRP)的變化.方法 隨機數字錶法將48例65歲以上髖部骨摺患者隨機分為2組:烏司他丁組(21例)與對照組(27例).所有患者均行腰硬聯閤阻滯痳醉.烏司他丁組在切皮前和手術結束即刻分彆給予烏司他丁5 000 U/kg緩慢靜脈點滴.分彆于術日(T0)、術後第1天(T1)、術後第3天(T2)、術後第7天(T3)清晨對患者進行簡易智能狀態量錶評分(MMSE),計算各組認知功能障礙(POCD)髮生率.于T0及T2時點抽取靜脈血,測定血漿CRP濃度.結果 T1及T2時點烏司他丁組MMSE評分為(26.0±0.7)和(26.6±0.6),高于對照組的(23.8±0.8)和(24.3±0.7),差異有統計學意義(￡1=2.161,t2=2.431,P＜0.05),T0及T3時2組MMSE評分分彆為(26.9±0.5)、(26.7±0.6)分和(26.5±0.5)、(25.2±0.7)分,差異無統計學意義(t0=0.472,t3=1.585,P＞0.05).患者術後POCD總髮生率分彆為4.8％和40.7％,烏司他丁組低于對照組(x2=8.155,P＜0.01).烏司他丁組術後CRP為(64.46±9.86)mg/L,低于對照組的(123.63±7.17) mg/L,差異有統計學意義(t=-4.974,P＜0.05).結論 烏司他丁預處理可明顯降低老年髖部骨摺患者POCD的髮生率,可能與其抗炎作用有關.
목적 대노년관부골절환자술전예방성응용오사타정,관찰기술후인지공능급C반응단백(CRP)적변화.방법 수궤수자표법장48례65세이상관부골절환자수궤분위2조:오사타정조(21례)여대조조(27례).소유환자균행요경연합조체마취.오사타정조재절피전화수술결속즉각분별급여오사타정5 000 U/kg완만정맥점적.분별우술일(T0)、술후제1천(T1)、술후제3천(T2)、술후제7천(T3)청신대환자진행간역지능상태량표평분(MMSE),계산각조인지공능장애(POCD)발생솔.우T0급T2시점추취정맥혈,측정혈장CRP농도.결과 T1급T2시점오사타정조MMSE평분위(26.0±0.7)화(26.6±0.6),고우대조조적(23.8±0.8)화(24.3±0.7),차이유통계학의의(￡1=2.161,t2=2.431,P＜0.05),T0급T3시2조MMSE평분분별위(26.9±0.5)、(26.7±0.6)분화(26.5±0.5)、(25.2±0.7)분,차이무통계학의의(t0=0.472,t3=1.585,P＞0.05).환자술후POCD총발생솔분별위4.8％화40.7％,오사타정조저우대조조(x2=8.155,P＜0.01).오사타정조술후CRP위(64.46±9.86)mg/L,저우대조조적(123.63±7.17) mg/L,차이유통계학의의(t=-4.974,P＜0.05).결론 오사타정예처리가명현강저노년관부골절환자POCD적발생솔,가능여기항염작용유관.
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 (x2 =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.
