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| 乌司他丁对老年患者髋部骨折术后谵妄的影响 |
| Effect of ulinastatin on postoperative delirium in elderly patients receiving hip fracture surgery |
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| DOI： |
| 中文关键词: 乌司他丁 老年患者 术后谵妄 髋部骨折 |
| 英文关键词: Ulinastatin Elderly patients Postoperative delirium Hip fracture |
| 基金项目:山东省科技发展计划(2011GSF11801) |
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| 中文摘要: |
| 目的 评价围术期静脉输注乌司他丁对老年患者髋部骨折术后谵妄(POD)的影响。方法 选择择期行髋部骨折手术的老年患者96例,男38例,女58例,年龄70～93岁,ASA Ⅱ或Ⅲ级,采用随机数字表法分为两组:乌司他丁组(U组)和对照组(C组),每组48例。麻醉方式均采用腰 硬联合麻醉+髂筋膜间隙阻滞。U组于切皮前、术后第1天和第2天静脉泵入乌司他丁5 000 U／kg;C组给予等容积生理盐水。术后1～3 d采用意识错乱评估法(CAM)评定POD的发生情况。分别于麻醉前(T0)、术毕(T1)和术后第3天(T2)采集外周静脉血5 ml,采用ELISA 法检测血清IL-6和S100β的水平。结果 C组POD发生13例（28.2%）,U组POD发生2例（4.3%）,U组POD发生率明显低于C组(P<0.05);与T0时比较,T1、T2时C组血清IL-6和IL-10水平明显升高(P<0.05);T1、T2时U组血清IL 6水平明显低于C组(P<0.05)。与T0时比较,T1时C组S100β水平明显升高(P<0.05);T1时U组血清S100β水平明显低于C组(P<0.05)。结论 乌司他丁降低老年髋部骨折患者POD发生率,机制可能与抑制血清促炎症因子IL-6和S100β的过度释放相关。 |
| 英文摘要: |
| Objective To explore the effect of ulinastatin treatment on postoperative delirium (POD) in elderly patients receiving hip fracture surgery. Methods Ninety six elderly patients (38 males, 58 females, aged 70-93 years, ASA grade Ⅱ or Ⅲ) undergoing elective hip fracture surgery were randomly divided into two groups using a random number table: ulinastatin group (group U) and control group (group C), 48 cases in each group. After spinal anesthesia and fascia iliaca compartment block, ulinastatin 5 000 U／kg diluted with normal saline to a volume of 50 ml (group U) was administered intravenously over 10 min before surgical incision and the equal doses on post-operative days 1, 2. The equal volume of normal saline was administered intravenously in group C at the same time. POD was assessed by using the Confusion Assessment Method (CAM) on post-operative days 1-3. Serum samples were collected to measure the levels of IL-6, IL-10 and S100β before the anesthesia (T0), at the end of surgery (T1) and three days after surgery (T2) by ELISA. Results The incidence of POD in group U was significantly lower than that in group C (4.3% vs. 28.2%) (P<0.05). Compared with T0, the levels of serum IL-6 and IL-10 in group C at both T1 and T2 significantly increased (P<0.05). Compared with group C, serum IL-6 levels in group U decreased at both T1 and T2 (P<0.05). Compared with T0, the levels of serum S100β in group C at T1 significantly increased (P<0.05). Compared with group C, ulinastatin significantly inhibited the release of serum S100β at T1 (P<0.05). Conclusion Ulinastatin can significantly reduce the incidence of POD in elderly patients undergoing hip fracture surgery. The mechanism may involve inhibition of IL-6 and S100β in serum. |
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