【摘要】 背景:乌司他丁是从人尿液中分离纯化提取的广谱胰蛋白酶抑制药。其主要药理机制是抑制溶酶体酶等多种水解酶的过度释放,从而改善组织灌注和微循环。目前关于乌司他丁对全膝关节置换后急慢性疼痛及置换后深静脉血栓发生率的影响报道较少。目的:观察乌司他丁对应用充气式止血带条件下接受双侧全膝关节置换患者的炎性递质、置换后疼痛、置换后凝血功能、下肢深静脉和浅静脉血栓发生率及置换后肢体功能恢复的影响。方法:选择接受双侧全膝关节置换的患者72例,随机分为对照组和试验组,各36例。试验组静脉给予乌司他丁,对照组给予等剂量生理盐水。所有患者麻醉镇痛方案及置换后功能康复方案均相同。在不同时间点检测患者炎症指标、凝血指标,观察静息和活动时的疼痛评分及置换后恢复质量评分。根据下肢血管超声检查结果分析置换后血栓形成情况。结果与结论:试验组部分时间点的炎症因子水平低于对照组(P<0.05)。试验组置换后4 h的静息疼痛目测类比评分显著低于对照组(P<0.05)。各时间点两组患者凝血功能指标差异无显著性意义(P>0.05)。与推入手术室时比较,置换后4,24 h时两组患者纤维蛋白原水平均明显下降,置换后48 h时明显升高(P均<0.05);置换后24,48 h时两组活化部分凝血活酶时间均明显延长(P<0.05);置换后4-48 h时两组D-二聚体表达水平明显升高(P<0.05)。与对照组相比,试验组血栓条数显著减少,血栓总长度明显短,差异均有显著性意义(P<0.05)。试验组在置换后4 h、置换后1,3,5,7 d置换后恢复质量评分均高于对照组(P<0.05)。提示乌司他丁可以减轻全膝关节置换患者的炎性反应,缓解置换后早期的疼痛,减少下肢肌间静脉血栓形成数量,减缓血栓形成的速度,提高患者置换后恢复质量。更多还原

【Abstract】 BACKGROUND: Ulinastatin is a broad spectrum of trypsin inhibitor purified and extracted from human urine. Its main pharmacological mechanism is to inhibit the excessive release of lysosomal enzymes and to improve tissue perfusion and microcirculation. Studies addressing ulinastatin effects on acute and chronic pain after total knee arthroplasty and the incidence of postoperative deep vein thrombosis are rare. OBJECTIVE: To observe the effects of ulinastatin on inflammatory mediators, postoperative pain, postoperative coagulation, incidence of deep vein and superficial vein thrombosis and the recovery of postoperative limb function in patients undergoing bilateral total knee arthroplasty using inflatable tourniquet.METHODS: A total of 72 patients receiving bilateral total knee arthroplasty were equally and randomly divided into control group and experimental group. Experimental group received intravenous infusion of ulinastatin and control group received an equal volume of normal saline. All patients received the same general and postoperative analgesia and rehabilitation protocols. The inflammation and coagulation indicators were recorded at different time points. The pain score at rest and activity and postoperative quality of recovery score were observed. According to the results of lower extremity vascular ultrasound, we analyzed the incidence of thrombosis. RESULTS AND CONCLUSION: Levels of inflammatory cytokines of the experimental group were lower than that in the control group at partial time points(P < 0.05). Visual Analogue Scale score at rest and activity in the experimental group at 4 hours after the surgery was significantly lower than that in the control group(P < 0.05). No significant difference in coagulation parameters at each time point was found between the two groups(P > 0.05). Compared with the time of entering the operation room, fibrinogen levels were significantly lower at 4 and 24 hours after surgery in both groups, but significantly higher at 48 hours(P < 0.05). Activated partial thromboplastin time was significantly longer in both groups at 24 and 48 hours after surgery(P < 0.05). At 4-48 hours after surgery, D-Dimer expression was significantly increased in the two groups(P < 0.05). Compared with the control group, the number of thrombosis was reduced and total length of the thrombosis was significantly shorter in the experimental group(P < 0.05). Postoperative quality of recovery score was higher in the experimental group at 4 hours, 1, 3, 5, and 7 days after surgery than in the control group(P < 0.05). These data indicate that ulinastatin can alleviate inflammatory response and early postoperative pain scores at rest and activity, reduce quantity of inter-vein thrombosis of lower extremity muscle, slow the speed of thrombosis and improve the quality of postoperative recovery in patients undergoing total knee arthroplasty.更多还原