摘要
目的:探讨围手术期应用乌司他丁对老年髋关节置换患者术后并发症的预防作用。方法:自2009年8月至2010年6月,选择择期行髋关节置换术的老年患者160例,男81例,女79例;年龄65～83岁,平均73.9岁。按美国麻醉医师协会病情估计分级(ASA)属Ⅰ-Ⅱ级。采用随机数字表法将患者随机分为对照组(C组)和乌司他丁组(U组),每组80例。U组手术切皮前一次性注射乌司他丁1万U/kg,术后l、2、3d缓慢静脉注射乌司他丁5000U/kg;C组只给予等量生理盐水。分别于术前1d、术毕及术后1、2、3d采血测定肝肾功能,包括谷丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血肌酐(Scr)、尿素氮(BUN)和D二聚体水平,并于术后3d应用彩色多普勒超声检查下肢深静脉血栓(DVT)形成,简易智能状态检查法(MMSE)进行认知功能障碍(POCD)测试。结果:与术前比较,两组患者术后ALT、AST、Scr、BUN和D二聚体水平均升高;与C组比较,U组术后ALT、AST、Scr、BUN和D二聚体水平降低(P<0.05)。术后3d,C组有32例形成DVT(40%),22例发生POCD(27.5%),U组无DVT发生,仅3例发生POCD(3.75%)。结论:围手术期应用乌司他丁能保护重要脏器功能,改善高凝状态,降低DVT和POCD的发生,一定程度预防术后并发症。
Objective：To evaluate the preventive effects of ulinastatin（Uti） on postoperative complications in elderly patients undergoing hip joint replacement.Methods：From Angust 2009 to June 2010,160 elderly patients undergoing selective hip joint replacement with ASAⅠtoⅡwere assessed according to American Society of Anesthesiologists classification,including 81 males and 79 females ranging in age from 65 to 83 years （mean 73.9 years）.All the patients were divided into 2 groups according to random number table（80 patients in each group）：control group（group C） and ulinastatin group（group U）.The patients in Group U received intravenous injection of ulinastatin with a dose of 10 000 U/kg before skin incision,and then with dose of 5 000 U/kg respectively at1,2 and 3 days after operatio.The patients in Group C received the same volume of normal saline instead of ulinastatin.Blood samples were taken preoperatively,at the end of surgery and 1,2,3 days after operation for determination of ALT,AST,Scr,BUN and Plasma D-dimer.Deep vein thrombosis and postoperative cognitive dysfunction（POCD） were also examined through color Doppler ultrasonography and neuroeognirive assessment on the postoperative 3 days respectively.Results：Compared with the preoperative values,the contents of ALT,AST,Scr,BUN and plasma D-dimer in each group all increased.Compared with group C,the values of ALT,AST,Scr,BUN and plasma D-dimer decreased markedly（P0.05）.The incidence rate of DVT and POCD was 0 and 3.75% in group U,which were lower than those of patients in the group C（40%,27.5%） respectively.Conclusion：Intravenous infusion of ulinastatin during operation can protect important organ function,correct blood hypercoagulability,lower the occurrence of DVT and POCD,and prevent the postoperative complications in some degree.
出处
《中国骨伤》
CAS
2011年第6期459-462,共4页
China Journal of Orthopaedics and Traumatology
