[Effect of ulinastatin on post-operative cognition disorders in elderly patients undergoing hip joint replacement].

Objective:To evaluate the effect of ulinastatin on post operative Cognition disorders in elderly patients undergoing hip joint replacement. Methods:Fourty ASAⅠorⅡelderly patients undergoing selective hip joint replacement,aged≥ 65 years,were randomly divided into 2 groups (n=40 each):control group and ulinastatin group. Ulinastatin group received iv infusion of ulinastatin (10 000 u / kg) after skin incision,(5 000 U / kg ) after operation 1,2,3 d respectively,included 21 males and 19 females with an average age of (75.00±7.81)years old. Control group received the same volume of normal saline instead of ulinastatin,included 20 males and 20 females with an average age of (72.80±7.25) years old. Neuroeognitive testing was performed on the preoperative day and on the 3th postoperative day and post operative cognition disorders was defined as 1 SD decline from baseline on neuroeognirive assessment. Serum S100β protein were measured before operation,at the end of surgery,3,24 h and 3 d after operation. Results:The incidence rate of postoperative cognition disorders was 2.5% in ulinastatin group,there were lower than those of patients in the control group(25%) (P0.05);In control group,the scales for MMSE before and after operation were (25.2±2.1),(22.6±2.5) scores and the level of serum S100β protein at T0-4 were (0.041± 0.012),(0.125±0.031),(0.178±0.036),(0.142±0.038),(0.048±0.015) μg / L. As well in ulinastatin group,above date were (25.9±2.4),(24.8±2.1),(0.040±0.013),(0.095±0.021),(0.116±0.017),(0.087±0.019) and (0.043±0.012) respectively. Compared with preoperative,MMSE evaluation scale was decreased on the 3th postoperative day and the S100β was increased markedly at T1-3 in control group(P0.05);Compared with control group,MMSE evaluation scale was increased and the S100β was decreased markedly at T1-3 in ulinastatin group(P0.05 ). Conclusion:Intravenous infusion of ulinastatin during operation can prevent the occurrence of POCD in elderly patients.