乌司他丁复合帕瑞昔布钠对老年患者髋关节置换术后早期细胞免疫及认知功能的影响

发布时间：2018-01-26 19:57

  本文关键词： 乌司他丁 帕瑞昔布钠 免疫细胞 认知功能　出处：《临床麻醉学杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨乌司他丁联合帕瑞昔布钠对老年患者单侧髋关节置换术后早期细胞免疫及认知功能的影响。方法选择择期行单侧髋关节置换术患者100例,性别不限,年龄65~80岁,随机分为四组:乌司他丁组(W组)、帕瑞昔布钠组(P组、乌司他丁联合帕瑞昔布钠组(WP组)和生理盐水对照组(C组),每组25例。W组于切皮前、手术结束即刻分别给予乌司他丁5 000U/kg;P组于麻醉诱导前给予帕瑞昔布钠40mg,之后40mg/12h,共6次;WP组于切皮前、手术结束即刻分别给予乌司他丁5 000U/kg,30min内泵注完毕,并于麻醉诱导前给予帕瑞昔布钠40mg,之后40mg/12h,共6次;C组于相同时点给予等量生理盐水。记录患者手术时间、术中出血量、自体血输注量和芬太尼总用量;于入室前(T_0)、术毕(T_1)、术后6h(T_2)、24h(T_3)及72h(T_4)采集外周静脉血,采用流式细胞术检测血T淋巴细胞(CD3~+、CD4~+、CD8~+),计算CD4~+/CD8~+值,同时采用ELISA法测定各时点血清IL-6、TNF-α、神经元特异性烯醇化酶(NSE)浓度和S100β蛋白含量。分别于T_0、T_4和术后7d(T5)时对患者进行简易智能状态量表(MMSE)评分。结果与T_0时比较,C、W和P组T_1~T_4时CD3~+、CD4~+细胞含量及CD4~+/CD8~+值明显降低,IL-6和TNF-α浓度明显升高,T_2、T_3时NSE浓度和S100β蛋白含量明显升高(P0.05);T_2、T_3时W和P组,T_1~T_4时WP组CD3~+、CD4~+细胞含量及CD4~+/CD8~+值明显高于,IL-6、TNF-α、NSE浓度和S100β蛋白含量明显低于C组(P0.05);T_2、T_3时WP组CD3~+、CD4~+细胞含量及CD4~+/CD8~+值明显高于,IL-6、TNF-α、NSE浓度和S100β蛋白含量明显低于W和P组(P0.05)。与T_0时比较,T_4、T5时C组MMSE评分明显降低(P0.05);T_4时W、P和WP组MMSE评分明显高于C组(P0.05);T_4时WP组患者MMSE评分明显高于W和P组(P0.05)。结论乌司他丁联合帕瑞昔布钠可改善老年患者单侧髋关节置换术细胞免疫功能及认知功能,较单独使用效果更好。
[Abstract]:Objective to explore the effect of early cellular immune function and cognitive function in elderly patients with unilateral hip arthroplasty after he d combined with parecoxib treatment. Methods 100 patients undergoing unilateral hip replacement patients, male or female, age 65~80 years old, were randomly divided into four groups: Ulinastatin group (group W). Parecoxib sodium group (P group, ulinastatin combined with parecoxib sodium group (group WP) and saline control group (C group), each group of 25 cases in group.W before skin incision, at the end of surgery were given Ulinastatin 5 000U/kg before induction of anesthesia in group P; parecoxib sodium 40mg, after 40mg/12h, a total of 6 times; in group WP before skin incision, at the end of surgery were given Ulinastatin 5 000U/kg, 30min infusion is completed, and before induction of anesthesia in parecoxib sodium 40mg, after 40mg/12h, a total of 6 times; at the same time C group received normal saline were recorded. The operation time, intraoperative bleeding 閲，

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