The Effects Of Different Doses Of Ulinastatin On Post-operative Cognitive Function And HMGB1 In Elderly Patients

Objective:To study the influences of ulinastatin on post operative cognitive dysfunction and the plasma concentration of HMGB1in elderly patients;and to explore the appropriate dose of ulinastatin.Methods:From May 2020 to September 2020,60 elderly patients older than 60 years old who underwent elective surgery in our hospital were selected,including 36 males、24 females、age 60-84 years、weight 46-74kg、ASA grade Ⅰ-Ⅱ。According to the random number table method,they were randomly divided into The experimental(U1,U2,U3)group and the control group(group C),15 cases per group.Before induction of anesthesia,the experimental group was infused with ulinastatin 5,000u/kg,10,000 u/kg,15,000 u/kg intravenously with 100 liters of 0.9%normal saline,and the control group was given the same dose of normal saline intravenously.Record the patient’s gender,age,education background,weight,perioperative conditions,hoshospitalization days,postoperative analgesia score,etc.;collect patients 5 minutes after entering the room(T1),5 minutes before leaving PACU(T2),and 1 day after surgery(T3),3 days(T4)venous blood,use double antibody sandwich enzyme-linked immunosorbent assay to monitor the patient’s hmgb1 concentration;use the MMSE scale method to evaluate the patient’s preoperative(T1),postoperative 1(T2),3(T3),5(T4),7(T5)days of cognitive function.Results:There was no statistically significant difference in the general characterise of four groups of patients.The was no significant difference in the anesthesia time,operative time,dosage of anesthetic,and the amount of access(P>0.05).The incidence of HMGB1 in 15,000 u/kg Ulinastatin group was 13%compared with 46%in the control group.The concentration of HMGB1 in each group of patients showed that T2,T3,and T4 were higher than that at T1(P<0.05),but at T4 was slightly lower than that at T3;5 min before out of the PACU(T2),15,000 u/kg The HMGB1 in the UTI group did not rise significantly as compared to the blank group(P<0.05);on the first day after surgery(T3),the HMGB1 concentration in the 10,000 u/kg and 15,000 U/kg dose groups was significantly lower than the C group(P<0.05).There was no statistical difference in the basic MMSE grade of patients in each group.The MMSE scores of the different doses of UTI group showed a downward trend at 1 and 3 days after surgery(P<0.05),and began to recover on the 5th day.There was a statistically significant difference between 5 and 7 days and 1 day after surgery(P<0.05);T2 and T3,the MMSE score of the control group was significantly lower than that of the 15,000 u/kg U group(P<0.05).The VAS score of postoperative was P>0.05,and there was no significant difference in the hospital stay of postoperative(P>0.05).Conclusions:15,000 u/kg ulinastatin can reduce general anesthesia Elderly patients undergoing elective laparoscopic surgery can reduce the incidence of POCD.The mechanism may be related to the reduction of HMGB 1 in circulating blood.