The Effects Of Ulinastatin On Hign Risk Factors Of Perioperative Stroke In Old Patients

Objective:To observe the changes of PTS markers in old patients who were given different doses of ulinastatin undergoing abdominal operations, and thereby to prognose the effects of ulinastatin on high risk factors of perioperative stroke in old patientsMethods:It is a prospective randomized control study.33 ASAⅠ—Ⅱold patients scheduled for selective abdominal surgeries were randomly divided into three groups(n=11 each):control group (group A) and two ulinastatin groups (group B and C)。Anesthesia was induced with fentanyl 3ug/Kg, propofol 2mg/Kg, succinylcholine 1.5-2mg/Kg. The patients were intubated and mechanically ventilated. Anesthesia was maintained with inhalation of sevoflurane. The patients were given 0.375% bupivacaine to maintain the block level. Group B received iv infusion of ulinastatin 300,000U before operation, while group C received ulinastatin 600,000U.All groups were finished by patient-controlled epidural analgesia (PCEA). Blood samples were taken at pre-anesthesia(T1), the end of intubation(T2), the end of operation(T3) and postoperative 72 h(T4) to determine activation variables of platelet (vWF), coagulation variables (FIB), anticoagulation variables (TAT) and fibrinolysis variables (D-Di-mer).Results:(1)vWF:vWF levels were significantly decreased in group B and C at T3 compared with those in group A (P<0.05) and there was no significant difference between group B and C(P>0.05). There were no significant changes in each group throughout the procedure. (2)FIB:FIB levels were significantly lower in group B and C at T3 and T4 compared with those in group A (P<0.01)and there was no difference between group B and C (P>0.05).FIB levels in group A elevated postoperatively, but decreased in group B at the end of intubation and in group C at the end of operation. (3)TAT:TAT levels in three groups were not significantly changed through-out the procedure and there was no difference among the three groups (P>0.05). (4)D-Dimer:D-Dimer levels were elevated postoperatively in group A and B and at the end of operation in group C(P<0.05). D-Dimer levels were higher in group A at T3 and T4 than those in group B and C(P<0.01), but there was no difference between group B and C(P>0.05).Conclusions:Administration of ulinastatin before surgery can improve the prethrombotic state associated with perioperative stroke in old patients undergoing abdominal surgery and contribute to reduce the risk of peri-operative stroke. There is no difference betweeen the effect of adminis-tration of usual doses of ulinastatin and high doses of that on high risk of perioperative stroke.