Ulinastatin May Significantly Improve Postoperative Cognitive Function of Elderly Patients Undergoing Spinal Surgery by Reducing the Translocation of Lipopolysaccharide and Systemic Inflammation
机构：[1]Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China,麻醉手术科首都医科大学宣武医院[2]Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China骨科首都医科大学宣武医院
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%, chi(2) = 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.
基金：
This study was supported by Beijing Municipal Administration
of Hospitals Clinical Medicine Development of Special
Funding Support (Nos. ZYLX201818 and ZYLX201706),
Beijing Municipal Administration of Hospital Ascent Plan (No.
DFL20150802), National Clinical Research Center for Geriatric
Disorders, Beijing, China, Beijing Municipal Commission of
Health and Family Planning (Nos. PXM2018_026283_000002
and PXM2017_026283_000002), and Xuanwu Hospital of Capital
Medical University, Beijing Institute of Geriatrics, Beijing,
China.
第一作者机构：[1]Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China,
通讯作者：
通讯机构：[1]Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China,
推荐引用方式(GB/T 7714)：
Zhang Min,Zhang Yan-Hua,Fu Hui-Qun,et al.Ulinastatin May Significantly Improve Postoperative Cognitive Function of Elderly Patients Undergoing Spinal Surgery by Reducing the Translocation of Lipopolysaccharide and Systemic Inflammation[J].FRONTIERS IN PHARMACOLOGY.2018,9(OCT):1007.doi:10.3389/fphar.2018.01007.
APA：
Zhang, Min,Zhang, Yan-Hua,Fu, Hui-Qun,Zhang, Qing-Ming&Wang, Tian-Long.(2018).Ulinastatin May Significantly Improve Postoperative Cognitive Function of Elderly Patients Undergoing Spinal Surgery by Reducing the Translocation of Lipopolysaccharide and Systemic Inflammation.FRONTIERS IN PHARMACOLOGY,9,(OCT)
MLA：
Zhang, Min,et al."Ulinastatin May Significantly Improve Postoperative Cognitive Function of Elderly Patients Undergoing Spinal Surgery by Reducing the Translocation of Lipopolysaccharide and Systemic Inflammation".FRONTIERS IN PHARMACOLOGY 9..OCT(2018):1007
