The Effects Of Ulinastatin On S100β Protein And Postoperative Cognitive Disfunction Of Patients Undergoing Isolated Cardiac Valve Replacement Operation

Objective:To explore the effects and possible mechanism of ulinastatin on S100βprotein and postoperative cognitive disfunction of patients undergoing isolated cardiac valve replacement operationMethod:Sixty patients undergoing isolated cardiac valve replacement operation were randomly divided into three groups ( n=20 ) :the small-dose(1.2×104U/Kg)of UTI group(group U1), the high-dose(2.4×104U/Kg)of UTI group(group U2), the control group(group C). With Inhalation-Intravenous combined anesthesia, in group U1 and U2, 30% of the total UTI dose was given after anesthesia, 40% of the total dose was given in priming fluid of CPB machine, and the remaining 30% was given 5 min before aortic declamping, while equal volume of normal saline was replaced in group C. Jugular bulb blood were drawed off at 5 min before the biginning of CPB(T1), 30 min after the biginning of CPB(T2), 30 minutes after the end of CPB(T3),6h after the end of surgery(T4), and 24h after the end ofsurgery(T5).S100βprotein was detected with the mehtod of ELISA. Patients were investigated with MMSE 1 day before operation,2 day after operation, 9 day after operation. Determine whether POCD occurred, and count the incidence rate of POCD.Result: There were no significent difference between the general information of the three groups(P>0.05).The level of S100βchanged in different time point. The level of S100βincreased obviously at 30 min after the biginning of CPB(T2) compared with 5 min before the biginning of CPB(T1), reached a peak at 30 minutes after the end of CPB(T3),then gradual declined at the T4,T5. At the T1 and the T5, post hoc test showed no statistically significant difference among groups C,U1,U2(P>0.05). There was significant difference between groups C and U2 at the T2,T3,T4(P<0.05). At the same time point ,there were no significant difference between groups C and U1, groups U1 and U2. There were no significant difference of the incidence rate of POCD among groups C,U1,U2(P>0.05).Conclusion: During the cardiac valve replacement operation , the CPB might be responsbile for the increasement of the level of S100β, and this effect had been persisting for many hours after the end of CPB. High-dose UTI could reduce the increasement of the level of S100β, possibly on account of which UTI could prevent and inhibit the systemic inflammatory reaction including encephalitis caused by CPB. The level of S100βat all time point were found significant different between the patients who had POCD and had no POCD, which the former was higher than the latter. What point out there was a positive correlation between S100βand POCD, while S100βcould be a good early index . There were no significant difference effect of POCD between groups U1 and C,groups U2 and C,but there were still a lot of work to do before proving that UTI could lessen the occurence of POCD.