右美托咪定和乌司他丁降低老年髋关节置换术后患者认知功能障碍效果的临床研究

The research of Dexmedetomidine and Ulinastatin reduce the postoperative cognitive dysfunction in the elderly patients undergoing total hip arthroplasty

目的 :观察围术期应用右美托咪定和乌司他丁降低老年髋关节置换术后患者认知功能障碍(postoperative cognitive dysfunction,POCD)发生率及围术期炎症因子的效果。方法 :选择全髋关节置换术老年患者120例随机分为四组,每组30例:A组采用术中右美托咪定静脉泵注,B组采用乌司他丁静脉滴注,C组采用右美托咪定联合乌司他丁滴注,D组为生理盐水静脉输注。四组患者均采用常规序贯诱导和全凭静脉麻醉。术前1d、术后3h、1d、3d时检测血清炎症因子(IL-6、TNF-α)浓度。于术前1d、术后1d、3d和6d采用简易认知状态检查(MMSE)量表进行认知功能评分,观察四组POCD发生率、炎症因子及相关指标的变化。结果 :A、C组苏醒时间较B、D组延长。A、C组丙泊酚和瑞芬用量较B、D组明显减少。四组术后各时点IL-6、TNF-α均有不同程度升高,与D组比较,A、B、C组升高不明显;与A、B组比较,C组术后各时点IL-6、TNF-α升高无差异;与D组比较,A、B、C三组术后各时点POCD发生率明显减少;与A、B组比较,C组术后各时点POCD发生率无差异。结论 :单独使用右美托咪定或乌司他丁可降低全髋关节置换术老年患者围术期POCD的发生率,但联合使用两种药物不能进一步降低POCD的发生率。

Objective To observe the effect of perioperative use of Dexmedetomidine and Ulinastatin reduce the postoperative cognitive dysfunction(POCD)and perioperative inflammation in the elderly patients undergoing total hip arthroplasty(THA).Methods One hundred and twenty elderly patients undergoing THA by general anesthesia were randomly allocated to four groups:receive intravenous dexmedetomidine(group A,30 cases),intravenous ulinastatin(group B,30 cases),intravenous both dexmedetomidine and ulinastatin(group C,30 cases)or the same volume of normal saline instead(group D,30 cases).The routine sequential induction and total intravenous anesthesia was applied to all groups.The interleukin(IL)-6 and tumor necrosis factor-α(TNF-α)were measured at the 1 d before surgery and 3 h,1 d,3 d after surgery.Mini-mental state examination(MMSE)scale was used to assess the cognitive function at 1 d before surgery and 1 d,3 d,6 d after surgery.The incidence rates of POCD,the changing of the inflammation factor and another related data were recorded.Results The recovery time of Group A and C were longer than Group B and D.The consumption propofol and remifentanil of Group A and C were less than Group B and D.The value of IL-6 and TNF-αwere rising at all different time after surgery in four groups.Compared with Group D,the rising of the value of IL-6 and TNF-αin Group A,B,C was lower.Compared with Group A,B,the rising of the value of IL-6 and TNF-αin Group C at all different time after surgery was no significant difference.Compared with Group D,the incidence rates of POCD in Group A,B,C were lower at all different time after surgery.Compared with Group A,B,the incidence rates of POCD in Group C was no significant difference at all different time after surgery.Conclusion Singly used Dexmedetomidine or Ulinastatin can reduce the incidence rates of POCD in the perioperative of eldly patients.But using intravenous both dexmedetomidine and ulinastatin can not reduce the incidence rates of POCD more than singly used in the perioperative of eldly patients.