Effect of ulinastatin on postoperative cognitive function in the elderly with fracture

Abstract

To observe the vary of postoperation cognitive function and inflammatory mediators CRP in elderly patients with fracture after using ulinastatin. Forty-eight patients over 65 years old patients with hip fracture were randomly divided into two groups: ulinastatin group (n = 21) and control group (n = 27). All patients underwent combined spinal-epidural anesthesia. The patients in ulinastatin group received intravenous injection of ulinastatin with a dose of 5 000 U/kg before skin incision and at the moment of the end of operation. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at the day of the operation (T₀), 1 (T₁), 3 (T₂) and 7 (T₃) days after opreation. The incidence of POCD was calculated. Blood samples were taken at the day of the operation and 3 days after operation for determination of CRP. Compared with control group (23.8 ± 0.8, 24.3 ± 0.7), the MMSE scores were significantly increased at T₁, T₂in ulinastatin group (26.0 ± 0.7, 26.6 ± 0.6) (t₁= 2.161, t₂= 2.431, P < 0.05). There were no differences at T₀0, T₃(t₀ = 0.472, t₃ = 1.585, P > 0.05). The respectively incidence of POCD of ulinastatin group and control group were 40.7% and 4.8%, and that of ulinastatin group was significantly lower than control group (χ² = 8.155, P < 0.01). Serum CRP concentration of ulinastatin group after operation was (64.46 ± 9.86) mg/L, significantly lower than control group (123.63 ± 7.17) mg/L (t = -4.974, P < 0.05). Ulinastatin can reduce the incidence of POCD in the elderly patients with fracture, which may be related to the anti-inflammatory effect of ulinastatin.