Abstract
Background: Studies have shown that perioperative inflammatory response is one of the important factors that caused postoperative cognitive dysfunction (POCD). Ulinastatin is a broad-spectrum protease inhibitor that inhibits inflammatory. We investigated the effects of ulinastatin on inflammatory response and early postoperative cognitive function in elderly patients undergoing spinal surgery.Methods: This clinical trial was approved by the Xuanwu Hospital Ethical Committee (Registration number: ChiCTR-IPR-16008931). Sixty elderly patients undergoing elective spinal surgery with American Society of Anesthesiologists (ASA) status of I–II were randomized into ulinastatin and control groups; total intravenous anesthesia was performed. The elderly patients in ulinastatin group underwent intravenous infusion of ulinastatin 10,000 units/kg following anesthesia induction and before surgical incision, and 5000 units/kg on post-operative days 1 and 2. Cognitive function was determined with Montreal Cognitive Assessment (MOCA) test preoperatively and on post-operative day 7 by a neurologist. Serum lipopolysaccharide (LPS), interleukin-6 (IL-6), C-reactive protein (CRP), and matrix metalloprotease-9 (MMP-9) concentration levels were measured at baseline, the end of surgery, and on post-operative days 1 and 3.Results: All elderly patients completed the study. Ulinastatin infusion significantly reduced the incidence of POCD in elderly patients undergoing spine surgery (ulinastatin group 16% vs. control group 43%, χ2 = 5.079, P = 0.024, P < 0.05). The elderly patients in ulinastatin group exhibited lower serum LPS, IL-6, CRP, and MMP-9 concentrations, as well as a shortened peak value duration, compared with those in the control group following surgery (P < 0.05).Conclusion: Systemic inflammation and translocation of LPS were inhibited by the infusion of ulinastatin in elderly patients undergoing spinal surgery. The anti-inflammation intervention with ulinastatin can significantly improve the elderly patients’ postoperative cognitive function.
Highlights
MATERIALS AND METHODSThe mechanism of postoperative cognitive dysfunction (POCD) in elderly individuals is related to excessive systemic inflammation caused by surgical trauma in elderly individuals, as well as an imbalance in the circulatory and central nervous system’s immune responses (Nathan and Rodney, 2008; Hu et al, 2010)
We interviewed the patients on the day before surgery and collected baseline data, including age, sex, gender, body-mass index (BMI), past medical history, education history, and Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA) score
We found that patients in the ulinastatin group had lower levels of inflammatory cytokines after the operation compared with the control group; further, there was a lower occurrence of POCD in the ulinastatin group, as assessed by neuropsychological testing
Summary
MATERIALS AND METHODSThe mechanism of postoperative cognitive dysfunction (POCD) in elderly individuals is related to excessive systemic inflammation caused by surgical trauma in elderly individuals, as well as an imbalance in the circulatory and central nervous system’s immune responses (increased pro-inflammatory substances and reduced anti-inflammatory substances) (Nathan and Rodney, 2008; Hu et al, 2010). Perioperative alarms include the release of high mobility group protein (HMGB1), neutrophils, and monocyte cytoplasmic proteins (S100A8 and S100A9) from sterile wound tissue (Lu et al, 2015; Susana and Mervyn, 2016). These can stimulate the systemic inflammatory response, which plays a key role in the occurrence and development of POCD. Studies have shown that perioperative inflammatory response is one of the important factors that caused postoperative cognitive dysfunction (POCD). We investigated the effects of ulinastatin on inflammatory response and early postoperative cognitive function in elderly patients undergoing spinal surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
