| Backgroud and Objective:Postoperative Cognitive Dysfunction(POCD) is defined as a neurologic postoperative complication in patients without mental disorders before operation. POCD is the comprehensive result of different factors with unclarified mechanism. Plenty of studies have suggested that the inflammatory in central nervous system was closely associated with cognitive dysfunction and age was one of the causes. Currently, there is no effctive method for the prevention and treatment of POCD. The main purpose of the current study was to investigate the effects of ulinastatin on serum interleukin-6(IL-6), tumor necrosis factor-alpha(TNF-a), S100 B protein concentration and early postoperative cognitive function in elderly patients undergo elective laparoscopic surgery with general anesthesia. Methods: Forty patients elder than 60 years, undergoing laparoscopic radical resection surgery for rectal or colonic cancer with general anesthesia were selected and randomly divided into two groups: ulinastatin(U group) and control group(C group), 20 cases in each group(n=20). Patients in group U were given 200000 U ulinastatin with 100 ml normal saline 30 minutes before anesthesia. Another ulinastatin was given by micro pump injection during the operation(100000U/h). The patients in group C recived the same volume of normal salineat the same time point. The levels of serum IL-6, TNF-α and S100 B were measured before ulinastatin infusion(T1), the end of operation(T2), as well as 2h(T3) and 24h(T4) post-operatively. Neuropsychological tests(Mini mental state examination, MMSE) were performed before operation, as well as one day and 3 days after operation. The patient was defined as POCD if the MMSE score was 2 or more points lower than that before operation. Results: 1.The comparison of the general conditions: There were no significant differences between the two groups in the aspects of age, gender(male/female), ASA degree(Ⅰ/Ⅱ/Ⅲ), body mass index, education level, smoking and drinking history, related indicators before anesthesia(including HR, MAP, Sp O2, BIS), the amount of anesthetic drugs(sufentanil, midazolam, vecuronium, etomidate, remifentanil, sevoflurane, propofol), time of anesthesia, time of operation, blood loss, transfusion volume, the amount of urine(P>0.05). 2. There was no significant difference between the two groups in serum level of IL-6 at T1(P>0.05). The levels of serum IL-6 increased at T2 and reached its peak, then decreased at T3 and T4, but still higher than T1(P<0.05). At T2, T3 and T4 time points, the serum level of IL-6 in group C was significantly higher than that in group U( 140.11±14.12 vs116.24±16.86, P<0.05; 138.74±12.36 vs113.77±15.16, P<0.05;103.78±12.98 vs65.50±9.41,P<0.05). There was no significant difference between the two groups in serum level of TNF-α at T1(P>0.05). The serum levels of TNF-α increased and reached the peak at T2, then decreased gradually at T3 and T4, but still higher than T1(P<0.05). Thelevels of serum TNF-α in group C were significantly higher than that in group U at T2, T3 and T4( 72.90±6.41 vs54.95±8.03, P<0.05;69.12±7.81 vs 49.80±6.80, P<0.05;56.36±6.98 vs43.98±5.14,P<0.05). There was no significant difference between the two groups in serum level of S100 B protein at T1(P>0.05). The serum levels of S100 B protein increased at T2, T3, T4 and reached its peak at T2, then decreased gradually at T3 and T4, but still higher than T1(P<0.05). At T2, T3 and T4, the levels of serum S100 B in group C were significantly higher than that in group U(617.3±78.6 vs460.8±45.2, P<0.05;603.4±92.0 vs454.0±53.3, P<0.05; 502.6±63.5 vs358.9±38.6, P<0.05). 50%(10/20) of patients in group C and 15%(3/20) of patients in group U developed POCD one day after surgery, respectively. The incidence rate of POCD between these two groups was statistically significant(P <0.05). Four patients(20%, 4/20) developed POCD 3 days after surgery in group C, but no POCD was diagnosed in group U, the difference was statistically significant(P<0.05). Conclusions: Ulinastatin can reduce the early incidence of POCD in elderly patients effectively by decreasing the release of inflammatory cytokines( IL-6、TNF-α) and inhibiting the inflammatory response in central nervous system. |
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