乌司他丁对膝关节置换术后关节炎症及周围肿胀的影响

Effect of Ulinastatin on Joint Inflammation and Peripheral Swelling after Knee Joint Replacement

目的探讨乌司他丁对全膝关节置换术后膝关节炎症及周围肿胀的影响。方法将择期行全膝关节置换手术的60例患者随机分为W组和C组,每组30例。W组于术中切皮前、术后第12 h分别静脉注射乌司他丁0.5万U/kg;C组给予等量的生理盐水,两组患者均采用相同的围手术期镇痛方案。记录两组患者术后关节腔引流量,关节周围肿胀程度及下肢深静脉血栓发生率;比较两组患者术后12 h、24 h关节腔引流液中白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果两组患者术后关节腔引流量及深静脉血栓发生率比较,差异无统计学意义(P>0.05);W组术后12 h,24 h髌上周径及腓肠肌周径低于C组,差异有统计学意义(P<0.05);W组术后12 h,24 h关节腔引流液IL-1β、IL-6、TNF-α低于C组,差异有统计学意义(P<0.05)。结论乌司他丁能降低患者术后关节腔炎性反应,缓解术后膝关节周围肿胀,且不增加下肢深静脉血栓发生率。

Objective To investigate the effect of ulinastatin on knee joint inflammation and peripheral swelling after total knee arthroplasty.Methods 60 patients undergoing elective total knee arthroplasty were randomly divided into W group and C group,30 cases in each group.In group W,ulinastatin was administered 0.5 million U/kg before and 12 h after surgery.Group C was given the same amount of normal saline.Both groups received the same perioperative analgesia.The postoperative joint cavity drainage,the degree of swelling around the joints and the incidence of deep venous thrombosis of the lower extremities were recorded.The interleukin-1β(IL-1β)and white blood cells in the joint cavity were compared between the two groups at 12 h and 24 h after operation.Interleukin 6(IL-6),tumor necrosis factor-α(TNF-α)levels.Results There was no significant difference in the incidence of postoperative joint drainage and deep venous thrombosis between the two groups(P>0.05).At 12 h after operation,the upper circumference and the circumference of the gastrocnemius muscle were lower in group W than in group C,the difference was statistically significant(P<0.05).The levels of IL-1β,IL-6 and TNF-αin the joint cavity of the W group were lower than those of the C group at 12 h and 24 h after operation,the difference was statistically significant(P<0.05).Conclusion Ulinastatin can reduce the postoperative articular inflammatory reaction and relieve the swelling around the knee joint without increasing the incidence of deep venous thrombosis.