乌司他丁对老年髋关节置换术后认知功能及血浆IL-6 IL-10 BDNF和S100β的影响

doi:10.3969/j.issn.1006-6233.2019.07.016

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摘要目的: 分析探讨老年髋关节置换术后MMSE评分与血浆IL-6、IL-10、BDNF和S100β的相关性及乌司他丁的改善作用。方法: 选取我院于2016年4月至2018年4月期间收治的92例行髋关节置换术的老年患者,按照随机数字表法将所有患者简单随机分为对照组和试验组两组,所有患者均进行静脉通路开放,并且均给予多功能监护仪进行生命体征监测,其中试验组患者分别在麻醉开始前和手术结束后静脉泵入5000U/kg乌司他丁,而对照组患者则分别泵入相同体积的生理盐水;所有患者均在侧卧位下采取腰硬联合麻醉。分别采用简易精神状态量表评估两组患者手术前后的认知功能,比较两组患者手术前后的血浆IL-6、IL-10、BDNF和S100β水平变化情况。结果: 对照组患者中有7例(15.22%)出现术后认知功能障碍,而试验组患者中则有1例(2.17%)出现术后认知功能障碍,两组数据比较差异具有统计学意义(P<0.05)。两组患者手术前的MMSE评分并无明显差异(t=0.329,P>0.05);对照组患者术后第3天的MMSE评分为(25.34±1.28)分,显著低于本组治疗前的(29.32±2.34)分,差异具有统计学意义(t=4.283,P<0.05);试验组患者术后第3天的MMSE评分为(28.52±1.27)分,显著高于同期对照组患者的(25.34±1.28)分,差异具有统计学意义(t=4.132,P<0.05)。两组患者手术结束时和术后第3天的IL-6和IL-10水平均显著高于本组治疗前(均P<0.05);其中试验组患者手术结束时和术后第3天的IL-6均显著低于同期对照组患者(均P<0.05);两组患者手术结束时和术后第3天的BDNF水平均显著低于本组手术前(均P<0.05);两组患者手术结束时的S100β水平均显著高于本组治疗前,并且试验组患者手术结束时的S100β水平显著低于同期对照组患者(均P<0.05)。结论: 对围术期老年髋关节置换患者使用乌司他丁能够有效改善其认知功能,改善其血浆IL-6、IL-10、BDNF和S100β水平,效果显著,值得在临床上加以广泛推广运用。

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	靖旭

关键词 ：髋关节置换术, 乌司他丁, 认知功能, 老年患者

Abstract：Objective: To investigate the correlation between MMSE score and plasma IL-6,IL-10,BDNF and S100β after hip arthroplasty in elderly patients and the improvement of ulinastatin. Methods: 92 elderly patients undergoing hip arthroplasty in our hospital from April 2016 to April 2018 were selected and randomly divided into control group and experimental group according to random number table method.All patients were given intravenous access and multi-function monitor for vital signs monitoring. The experimental group was given 5 000 U/kg Ulinastatin intravenously before and after anesthesia, while the control group was given the same volume of physiological saline. Simple mental state scale was used to evaluate the cognitive function of the two groups before and after operation. The changes of plasma levels of IL-6, IL-10, BDNF and S100 beta were compared between the two groups before and after operation. Results: There were 7 cases(15.22%)in the control group and 1 cases (2.17%) in the trial group with postoperative cognitive impairment. The difference between the two groups was statistically significant ( P<0.05). There was no significant difference in MMSE score between the two groups before operation (t = 0. 329, P>0. 05). The MMSE score of the control group was (25.34±1.28) on the 3rd day after operation, which was significantly lower than that before the treatment (29.32±2.34), and the difference was statistically significant (t=4.283, P<0.05). The MMSE score of the patients in the trial group was (28.52±1.27) on the 3rd day after operation, which was significantly higher than that in the control group (25.34±1.28), and the difference was statistically significant (t = 4.132, P<0. 05). The levels of IL-6 and IL-10 at the end of operation and on the third day after operation in both groups were significantly higher than those before treatment (P<0. 05). The IL-6 of the patients in the trial group was significantly lower than that in the control group at the end of operation and the third day after operation (all P<0. 05). On the 3rd day after operation, the level of BDNF was significantly lower than that before operation (all P<0. 05). The levels of S100β at the end of operation in both groups were significantly higher than those before treatment, and the levels of S100β at the end of operation in the trial group were significantly lower than those in the control group (all P<0.05). Conclusion: The use of ulinastatin in perioperative hip replacement patients can effectively improve their cognitive function and plasma IL-6,IL-10,BDNF and S100β levels, which is worthy of extensive clinical application.

Key words： Hip replacement Ulinastatin Cognitive function Gerontal patient

基金资助:江苏省自然科学基金项目,(编号:BK20160952号)

引用本文:

靖旭. 乌司他丁对老年髋关节置换术后认知功能及血浆IL-6 IL-10 BDNF和S100β的影响[J]. 河北医学, 2019, 25(7): 1116-1119.
JING Xu. Effect of Statine on Cognitive Function and Plasma IL-6 IL-10 BDNF and S100 Beta in Elderly Patients after Hip Arthroplasty. HeBei Med, 2019, 25(7): 1116-1119.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2019.07.016 或 http://www.hbyxzzs.cn/CN/Y2019/V25/I7/1116

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