| Objective:Inflammation plays a role in the pathogenesis of postoperative cognitive dysfunction.Surgical trauma can lead to activation of innate immune system.Ulinastatin as an anti-inflammatory drug,we decide to observe if ulinastatin can decrease the incidence of cognitive dysfunction in the early postoperative period after abdominal surgery in elderly.Method:Forty ASAâ… -â…¢patients aged 65-83 yr undergoing elective abdominal surgery were randomly divided into two groups:ulinastatin and control group,20 cases in each group.Patients in group U received 200000U ulinastatin with 100ml normal saline just before induction of anesthesia, another 100000U/h was added to the patients until the end of operation.In group C normal saline was given instead of ulinastatin in the same volume and at the same speed.Venous blood samples were collected immediately before induction of anesthesia(T1),4h after operation(T2) and 24h postoperatively(T3).The plasma levels of IL-1β,IL-6 and IL-10 were measured by enzyme-linked immunosorbent assay.The time of operation and anesthesia,blood volume and urinary volume were recorded and BP,HR and AEP index were also measured in both groups.A battery of neuropsychological tests was performed and scored preoperatively and 3 days after operation. Z-combined score suggested by Moller was applied to the diagnosis of cognitive dysfunction.Patients had cognitive dysfunction when two Z score in individual or the combined Z score were 1.96 or more.Results:There were no sigificant differences in the aspects of age, weight,gender,ASA degree,education,the time of operation and anesthesia, blood volume,HR,BP and AEP index between two groups.At T2 and T3, plasma IL-1β,IL-6 and IL-10 in both groups were significantly higher than that at T1.At T2 and T3,plasma IL-6 was lower in group U than that in group C(127.88±25.39 pg/ml VS 157.91±26.50 pg/ml;P＜0.01,86.38±13.45 pg/ml VS 98.03±20.03 pg/ml;P＜0.05),conversely,IL-10 was higher in group U than that in group C(106.93±21.36 pg/ml VS 86.93±17.65 pg/ml; P＜0.01,78.17±18.89 pg/ml VS 64.38±16.79 pg/ml;P＜0.05).In the test of Figural Memory and Auditory-Verbal Learning,the scores of both groups were greatly decreased compared with that preoperatively.The performance on Test Digit Span Subset in group U was better than that in group C(3.1±0.7 VS 2.6±0.9;P＜0.05).Postoperative cognitive dysfunction occurred in 7 patients(35%) in the group C and in 5 patients(25%) in the group U,there was no significant difference between two groups.Positive correlations were found between an elevation in IL-6 levels 4 h after operation and the high Z score(such as Figural Memory,Auditory-Verbal Learning,Test Digit Span Subset) 3 days later.(r=0.460,r=0.504,r=0.385,r=0.380 respectively).Conclusion:Ulinastatin can improve certain memory function postoperatively,but ulinastatin do not decrease the general incidence of cognitive dysfunction in the early postoperative period after abdominal surgery in elderly.Postive correlation was found between IL-6 and the decline of memory function. |
