[1]孙力,颜明*. 乌司他丁对老年全髋关节置换患者术中血流动力学和肺氧合功能的影响[J].徐州医科大学学报,2017,37(07):432-435.
 SUN Li,YAN Ming. Effects of ulinastatin on the hemodynamics and pulmonary oxygenation function of elderly patients during total hip arthroplasty[J].Journal of Xuzhou Medical University,2017,37(07):432-435.
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 乌司他丁对老年全髋关节置换患者术中血流动力学和肺氧合功能的影响()
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《徐州医科大学学报》[ISSN:2096-3882/CN:32-1875/R]

卷:
37
期数:
2017年07期
页码:
432-435
栏目:
出版日期:
2017-07-25

文章信息/Info

Title:
 Effects of ulinastatin on the hemodynamics and pulmonary oxygenation function of elderly patients during total hip arthroplasty
作者:
 孙力12颜明2*
 1.徐州医科大学江苏省麻醉学重点实验室,江苏徐州221004; 2.徐州医科大学附属医院麻醉科,江苏徐州221002
Author(s):
 SUN Li12 YAN Ming2
 1.Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China;
2.Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002
关键词:
乌司他丁全髋关节置换术血流动力学肺氧合功能
Keywords:
 ulinastatin total hip arthroplasty hemodynamics pulmonary oxygenation function
分类号:
R614
文献标志码:
A
摘要:
目的探讨乌司他丁对老年全髋关节置换患者术中血流动力学和肺氧合功能的影响。方法将40例行骨水泥型全髋关节置换术的老年患者随机分为2组:乌司他丁组(U组)和对照组(C组),每组20例。观察并分别记录手术开始时(T1)、髋臼假体置入(T2)、股骨锉髓腔(T3)、骨水泥植入(T4)、股骨假体置入(T5)、髋关节复位(T6)和术毕(T7)各时间点2组患者的心输出量(CO)、心脏指数(CI)、每搏量(SV)、每搏量指数(SVI)和平均动脉压(MAP)、心率(HR)等参数。同时记录T1、T3、T5、T6、T7各时间点的动脉血气分析结果,记录分析氧分压(PaO2)、二氧化碳分压(PaCO2)的变化。结果与T1相比,C组和U组在T3、T4、T5、T6和T7时,CO、CI、SV、SVI和MAP均有明显降低(P<0.05)。与C组相比,U组在T1、T2、T3、T4和T7时,CO、CI、SV、SVI和MAP均无明显差异(P>0.05);在T5和T6时上述指标有显著差异(P<0.05)。2组患者术中HR的变化无明显差异(P>0.05)。U组去氧肾上腺素使用剂量较C组明显减少(P<0.05)。与T1相比,C组T3、T5、T6以及T7时,PaO2显著降低(P<0.05);U组在T5、T6以及T7时,PaO2显著降低(P<0.05)。与C组相比,U组在T5和T6时PaO2有明显差异(P<0.05)。两组患者术中PaCO2未见明显变化(P>0.05)。结论乌司他丁可以使老年全髋关节置换患者术中血流动力学更加稳定,同时对患者肺氧合功能也有一定的保护作用。
Abstract:
 ObjectiveTo explore the effects of ulinastatin on the hemodynamics and pulmonary oxygenation function of elderly patients during total hip arthroplasty. MethodsA total of 40 patients who underwent cemented total hip arthroplasty were randomly divided into two groups: an ulinastatin group (Group U) and a control group (Group C) (n=20). Then, the following indexes were recorded when the operation began (T1), when an acetabular prosthesis was inserted (T2), when the femur was reamed (T3), when bone cement was implanted (T4), when the femoral prosthesis was inserted (T5), when the hip was relocated (T6) and at the end of operation (T7): cardiac output (CO), cardiac index(CI), stroke volume (SV), stroke volume index (SVI), mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG), pulse oxygen saturation (SpO2), entropy index (RE/SE) and other parameters. Meanwhile, blood gas analysis was performed and the changes of partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were recorded at T1, T3, T5, T6 and T7. ResultsCompared with the results at T1, both Groups U and C presented remarkable decreases in CO, CI, SV, SVI and MAP at T3, T4, T5, T6 and T7 (P<0.05). Compared with Group C, marked differences were found in CO, CI, SV, SVI and MAP for Group U at T5 and T6 (P<0.05). No significant difference was found as to HR between the two group (P>0.05). The total dose of phenylephrine used in Group U during the operation was significantly lower than that in Group C (P<0.05). Compared with the results at T1, Group C presented remarkable decreases in PaO2 at T3, T5, T6 and T7 (P<0.05), while Group U showed markedly decreased PaO2 at T5, T6 and T7 (P<0.05). Compared with Group C, significant differences were found as to PaO2 for Group U at T5 and T6 (P<0.05). There was no significant change in PaCO2 between the two groups (P>0.05). ConclusionsUlinastatin can stablize the hemodynamics of elderly patients during total hip arthroplasty and protect the pulmonary oxygenation function in patients.

参考文献/References:

 [1]Jackson J. Father of the modern hip replacement: Professor Sir John Charnley (1911-82) [J]. J Med Biogr, 2011,19(4):151-156.
[2]Donaldson AJ, Thomson HE, Harper NJ, et al. Bone cement implantation syndrome [J]. Br J Anaesth, 2009,102(1):12-22.
[3]Powell JN, McGrath PJ, Lahiri SK, et al. Cardiac arrest associated with bone cement [J]. Br Med J, 1970,3(5718):326.
[4]Yamada T, Momwaki K, Shmroyama K, et al. High incidence of cardiorespiratory deterioration in patients receiving cemented hip hemiarthroplasty for femoral neck fracture [J]. Masui, 2007,56(7):810-816.
[5]Murphy P, Edelist G, Byrick RJ, et al. Relationship of fat embolism to haemodynamic and echocardiographic changes during cemented arthroplasty [J].Can J Anaesth, 1997,44(12):1293-1300.
[6]Koessler MJ, Fabiani R, Hamer H, et al. The clinical relevance of embolic events detected by transesophageal echocardiography during cemented total hip arthroplasty: a randomized clinical trial [J]. Anesth Analg, 2001,92(1):49-55.
[7]Modig J, Busch C, Olerud S, et al. Arterial hypotension and hypoxaemia during total hip replacement: the importance of thromboplastic products, fat embolism and acrylic monomers [J]. Acta Anaesthesiol Scand, 1975,19(1):28-43.
[8]Parvizi J, Holiday AD, Ereth MH, et al. The Frank Stinchfield Award. Sudden death during primary hip arthroplasty [J]. Clin Orthop Relat Res, 1999,369:39-48.
[9]Fallon KM, Fuller JG, Morley-Forster P. Fat embolization and fatal cardiac arrest during hip arthroplasty with methylmethacrylate [J]. Can J Anaesth, 2001,48(7):626-629.
[10]Motobe T, Hashiguchi T, Uchimura T, et al. Endogenous cannabinoids are candidates for lipid mediators of bone cement implantation syndrome [J]. Shock, 2004,21(1):8-12.
[11]Enneking FK. Cardiac arrest during total knee replacement using a long-stem prosthesis [J]. J Clin Anesth, 1995,7(3):253-263.
[12]Urban MK, Sheppard R, Gordon MA, et al. Right ventricular function during revision total hip arthroplasty [J]. Anesth Analg, 1996,82(6):1225-1229.
[13]Wheelwright EF, Byrick RJ, Wigglesworth DF, et al. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism [J]. J Bone Joint Surg Br, 1993,75(5):715-723.
[14]Belenkie I, Dani R, Smith ER, et al. Effects of volume loading during experimental acute pulmonary embolism [J]. Circulation, 1989,80(1):178-188.
[15]Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism: the pivotal role of pulmonary vasoconstriction [J]. Cardiovasc Res, 2000,48(1):23-33.
[16]Tryba M, Linde I, Voshage G, et al. Histamine release and cardiovascular reactions to implantation of bone cement during total hip replacement [J]. Anaesthesist, 1991,40(1):25-32.
[17]毛刚,吴清安,刘磊.乌司他丁的药理作用机制及临床应用进展[J]. 山东医药,2015,55(30):94-96.

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备注/Memo

备注/Memo:
 收稿日期:2017-04-17修回日期:2017-05-28
通信作者,E-mail:yjy3001@163.com
更新日期/Last Update: 2017-07-14