乌司他丁对老年患者髋部骨折术后谵妄的影响

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.%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.