术前应用乌司他丁对下肢关节置换术后肺部感染及炎性因子的影响

Effects of preoperative use of ulinastatin on postoperative pulmonary infection and inflammatory factors in patients undergoing lower limb arthroplasty

目的探索术前应用乌司他丁对下肢关节置换患者手术后肺部感染、谵妄及血清炎性因子的影响。方法选取2016年2月-2018年2月于成都军区总院接受治疗的216例下肢关节置换患者为研究对象,按照随机数表法分为对照组和试验组,每组各108例,试验组于术前应用乌司他丁加入100 ml生理盐水静脉滴注,对照组给予等量生理盐水静脉滴注。观察并比较两组患者肺部感染情况和谵妄发生情况,检测并比较两组患者的血清炎性因子水平。结果试验组患者术后肺部感染率为5.56%,住院时间为(12.14±3.67)d,均低于对照组患者的22.22%和(15.37±2.98)d(P<0.05);试验组患者手术完毕与手术后24 h的意识混乱评估方法(Consciousness Assessment,CMA)、术后谵妄(Postoperative Delirium,PD)发生率均低于对照组患者(P<0.05);试验组患者手术完毕的神经胶质细胞(Neuroglia Cell,S100β)、白细胞介素-6((Interleukin-6,IL-6)、白细胞介素-1β(Interleukin-1β,IL-1β)、肿瘤坏死因子-α(Tumor Necrosis Factor,TNF-α)水平均低于对照组患者(P<0.05);试验组患者术后24 h的S100β、IL-6、IL-1β水平均低于对照组患者(P<0.05)。结论术前应用乌司他丁可以降低下肢关节置换患者的术后肺部感染率和谵妄发生率,同时能够有效降低炎性因子的水平,对患者的预后具有积极作用。

OBJECTIVE To explore the effects of ulinastatin on postoperative pulmonary infection,delirium and serum inflammatory factors in patients undergoing lower limb arthroplasty.METHODS A total of 216 patients with lower extremity arthroplasty who were treated at the Chengdu Military Region General Hospital from Feb.2016 to Feb.2018 were enrolled.The patients were divided into the control group and the experimental group according to the random number table,with 108 patients in each group.Preoperative administration of ulinastatin was performed in the experimental group by intravenous infusion of 100 ml of normal saline,and the control group was given an equal amount of normal saline.The lung infection and delirium incidence were observed and compared between the two groups.Serum inflammatory factor levels were measured and compared between the two groups.RESULTS The postoperative pulmonary infection rate was 5.56%in the experimental group,and the hospital stay was(12.14±3.67)d,which was significantly lower than 22.22%and(15.37±2.98)d of the control group(P<0.05).The incidence of Consciousness Assessment(CMA)and Postoperative Delirium(PD)after operation and 24 h after operation was significantly ower than that of the control group(P<0.05).The levels of Neuroglia Cell(,S100β),Interleukin-6(IL-6),Interleukin-1β(IL-1β),and Tumor Necrosis Factor(TNF-α)in the experimental group were significantly lower than those of the control group after the operation(P<0.05).The levels of S100β,IL-6 and IL-1βin the experimental group were significantly lower than those in the control group at 24 h after operation(P<0.05).CONCLUSION Preoperative use of ulinastatin can significantly reduce the incidence of postoperative pulmonary infection and delirium in patients with lower limb arthroplasty,and can effectively reduce the levels of inflammatory factors and has a positive effect on the prognosis of the patients.