本文關(guān)鍵詞： 烏司他丁 帕瑞昔布鈉 免疫細(xì)胞 認(rèn)知功能　出處：《臨床麻醉學(xué)雜志》2017年04期 　論文類(lèi)型：期刊論文

【摘要】：目的探討烏司他丁聯(lián)合帕瑞昔布鈉對(duì)老年患者單側(cè)髖關(guān)節(jié)置換術(shù)后早期細(xì)胞免疫及認(rèn)知功能的影響。方法選擇擇期行單側(cè)髖關(guān)節(jié)置換術(shù)患者100例,性別不限,年齡65~80歲,隨機(jī)分為四組:烏司他丁組(W組)、帕瑞昔布鈉組(P組、烏司他丁聯(lián)合帕瑞昔布鈉組(WP組)和生理鹽水對(duì)照組(C組),每組25例。W組于切皮前、手術(shù)結(jié)束即刻分別給予烏司他丁5 000U/kg;P組于麻醉誘導(dǎo)前給予帕瑞昔布鈉40mg,之后40mg/12h,共6次;WP組于切皮前、手術(shù)結(jié)束即刻分別給予烏司他丁5 000U/kg,30min內(nèi)泵注完畢,并于麻醉誘導(dǎo)前給予帕瑞昔布鈉40mg,之后40mg/12h,共6次;C組于相同時(shí)點(diǎn)給予等量生理鹽水。記錄患者手術(shù)時(shí)間、術(shù)中出血量、自體血輸注量和芬太尼總用量;于入室前(T_0)、術(shù)畢(T_1)、術(shù)后6h(T_2)、24h(T_3)及72h(T_4)采集外周靜脈血,采用流式細(xì)胞術(shù)檢測(cè)血T淋巴細(xì)胞(CD3~+、CD4~+、CD8~+),計(jì)算CD4~+/CD8~+值,同時(shí)采用ELISA法測(cè)定各時(shí)點(diǎn)血清IL-6、TNF-α、神經(jīng)元特異性烯醇化酶(NSE)濃度和S100β蛋白含量。分別于T_0、T_4和術(shù)后7d(T5)時(shí)對(duì)患者進(jìn)行簡(jiǎn)易智能狀態(tài)量表(MMSE)評(píng)分。結(jié)果與T_0時(shí)比較,C、W和P組T_1~T_4時(shí)CD3~+、CD4~+細(xì)胞含量及CD4~+/CD8~+值明顯降低,IL-6和TNF-α濃度明顯升高,T_2、T_3時(shí)NSE濃度和S100β蛋白含量明顯升高(P0.05);T_2、T_3時(shí)W和P組,T_1~T_4時(shí)WP組CD3~+、CD4~+細(xì)胞含量及CD4~+/CD8~+值明顯高于,IL-6、TNF-α、NSE濃度和S100β蛋白含量明顯低于C組(P0.05);T_2、T_3時(shí)WP組CD3~+、CD4~+細(xì)胞含量及CD4~+/CD8~+值明顯高于,IL-6、TNF-α、NSE濃度和S100β蛋白含量明顯低于W和P組(P0.05)。與T_0時(shí)比較,T_4、T5時(shí)C組MMSE評(píng)分明顯降低(P0.05);T_4時(shí)W、P和WP組MMSE評(píng)分明顯高于C組(P0.05);T_4時(shí)WP組患者M(jìn)MSE評(píng)分明顯高于W和P組(P0.05)。結(jié)論烏司他丁聯(lián)合帕瑞昔布鈉可改善老年患者單側(cè)髖關(guān)節(jié)置換術(shù)細(xì)胞免疫功能及認(rèn)知功能,較單獨(dú)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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