Effects of ulinastatin with parecoxib sodium on early cellular immunology function and cognitive function in elderly patients undergoing total hip replacement / 临床麻醉学杂志

ABSTRACT

Objective To investigate the effects of ulinastatin with parecoxib sodium on early cellular immunology function and cognitive function in elderly patients undergoing total hip replacement.Methods One hundred patients (aged 65-80 years,ASA grade Ⅱ) undergoing elective total hip replacement were randomly assigned into 4 groups group W(n=25),group P(n=25),group WP(n=25) and group C(n=25).The patients in group W received intravenous injection of ulinastatin with a dose of 5 000 U/kg before skin incision and at the moment of the end of operation.Patients in group P accepted intravenous injection of parecoxib sodium of 40 mg before anesthesia and at a 12 h intervals for six times.Patients in group WP accepted intravenous injection of ulinastatin with a dose of 5 000 U/kg before skin incision and at the moment of the end of operation,and accepted intravenous injection of parecoxib sodium with a dose of 40 mg before anesthesia and at a 12 h interval for six times.Patients in group C were given normal saline at the same time as placebo.The operation time,the volume of bleeding and autologous blood receiving and the intraoperative fentanyl consumption were recorded in four groups.Blood samples were obtained before induction (T0),at the end of operation (T1),on 6 h (T2),24 h (T3),72 h (T4) after operation for determination of plasma concentration of S100β protein,neuron-specific enolase(NSE),IL-6,TNF-α.The percentages of T lymphocyte subsets (CD3+,CD4+,CD8+) and CD4+/CD8+ ratio were detected with flow cytometry.The Mini-Mental State Examination (MMSE) was used to test the cognitive function of the patients at T0,T4 and 7 d after operation (T5).Results Compared with T0,the percentages of CD3+,CD4+ cells and CD4+/CD8+ in groups C,W and P were significantly decreased,the plasma concentrations of IL-6 and TNF-α significantly increased at T1-T4,concentration of NSE and S100 protein were significantly increased at T2 and T3 (P<0.05).the percentages of CD3+,CD4+T lymphocyte and CD4+/CD8+ ratio in groups W and P at T2,T3 and group WP at T1-T4 was significantly higher than that of group C,the concentration of IL-6,TNF-α,NSE and S100β protein content was significantly lower than in group C (P<0.05);the percentages of CD3+,CD4+T lymphocyte and CD4+/CD8+ ratio in group WP was significantly higher than those of groups W and P,the concentrations of TNF-α,IL-6,NSE and S100β protein content was significantly lower than those of group W and P at T2,T3 (P<0.05).Compared with T0,MMSE score in group C was significantly lower at T4,T5 (P<0.05).MMSE score of groups W,P and WP was significantly higher than that of group C at T4 (P<0.05).MMSE score of group WP was significantly higher than those of groups W and P at T4 (P<0.05).Conclusion Ulinastatin combined with parecoxib sodium ameliorates early cellular immunology function and cognitive function in elderly patients undergoing total hip replacement,and it is more effective than using ulinastatin or parecoxib sodium alone.