Effects of ulinastatin on coagulation function and deep vein thrombosis in patients undergoing hip joint replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of ulinastatin (Uti) and low-molecular-weight heparin (Lmwh) on coagulation function and deep vein thrombosis (DVT) in patients undergoing hip joint replacement.</p><p><b>METHODS</b>From March to December 2010 150 ASAI-II patients with average age of 72.5 (65 - 85) years undergoing hip joint replacement were randomly divided into 3 groups (n = 50 each): normal saline (NS) control group (Group C), Uti group (Group U) and Lmwh group (Group L). Group U received intravenous infusion of ulinastatin (10 000 U/kg) at preoperative, perioperative and after operation 1, 2 and 3 d, respectively. Group C received the same volume of NS instead of Uti. Group L were injected Lmwh subcutaneously (3200 U/d) at preoperative, after operation 1, 2 and 3 d. Blood samples were taken before operation (T(0)), at the end of surgery (T(1)), 1 d (T(2)), 2 d (T(3)) and 3 d (T(4)) after operation for determination the values of R, K, α angle, MA and CI, using thromboelastography, and the DVT were also examined through color Doppler ultrasonography at 3 d after operation.</p><p><b>RESULTS</b>Compared with T(0), R, K were shorter, α angle, MA and CI were larger in group C, the values at T(2) were up to the peak then declined at T(4). Compared with group C, the value of R, K were larger, the value of α angle, MA and CI were shorter in group U and group L. The DVT checked by ultrasonography were found in 20 cases in group C, 1 case in group U, and zero case in group L. The differences were no statistically significant between group U and group L.</p><p><b>CONCLUSION</b>Intravenous infusion of Uti during the period of operation can correct the hypercoagulability of blood and decrease the incidence of DVT after operation.</p>

Effect of ulinastatin on post-operative cognition disorders in elderly patients undergoing hip joint replacement / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effect of ulinastatin on post-operative Cognition disorders in elderly patients undergoing hip joint replacement.</p><p><b>METHODS</b>Forty ASA I or II elderly patients undergoing selective hip joint replacement, aged > or = 65 years, were randomly divided into 2 groups (n = 40 each): control group and ulinastatin group. Ulinastatin group received iv infusion of ulinastatin (10,000 u/kg) after skin incision, (5,000 U/kg) after operation 1, 2, 3 d respectively, included 21 males and 19 females with an average age of (75.00 +/- 7.81) years old. Control group received the same volume of normal saline instead of ulinastatin, included 20 males and 20 females with an average age of (72.80 +/- 7.25) years old. Neuroeognitive testing was performed on the preoperative day and on the 3th postoperative day and post-operative cognition disorders was defined as 1 SD decline from baseline on neurocognitive assessment. Serum S100beta protein were measured before operation, at the end of surgery, 3, 24 h and 3 d after operation.</p><p><b>RESULTS</b>The incidence rate of postoperative cognition disorders was 2.5% in ulinastatin group, there were lower than those of patients in the control group (25%) (P < 0.05); In control group, the scales for MMSE before and after operation were (25.2 +/- 2.1), (22.6 +/-2.5) scores and the level of serum S100beta protein at T0-4 were (0.041 +/- 0.012), (0.125 +/- 0.031), (0.178 +/- 0.036), (0.142 +/- 0.038), (0.048 +/- 0.015) microg/L. As well in ulinastatin group, above date were (25.9 +/- 2.4), (24.8 +/- 2.1), (0.040 +/- 0.013), (0.095 +/- 0.021), (0.116 +/- 0.017), (0.087 +/- 0.019) and (0.043 +/- 0.012) respectively. Compared with preoperative, MMSE evaluation scale was decreased on the 3th postoperative day and the S100beta was increased markedly at T1-3 in control group (P < 0.05); Compared with control group, MMSE evaluation scale was increased and the S100beta was decreased markedly at T1-3 in ulinastatin group (P < 0.05 ).</p><p><b>CONCLUSION</b>Intravenous infusion of ulinastatin during operation can prevent the occurrence of POCD in elderly patients.</p>