Effect of ulinastatin on postoperative delirium in elderly patients receiving hip fracture surgery / 临床麻醉学杂志

ABSTRACT

Objective To explore the effect of ulinastatin treatment on postoperative delirium (POD) in elderly patients receiving hip fracture surgery.Methods Ninety-six elderly patients (38 males,58 females,aged 70-93 years,ASA grade Ⅱ or Ⅲ) undergoing elective hip fracture surgery were randomly divided into two groups using a random number table ulinastatin group (group U) and control group (group C),48 cases in each group.After spinal anesthesia and fascia iliaca compartment block,ulinastatin 5 000 U/kg diluted with normal saline to a volume of 50 ml (group U) was administered intravenously over 10 min before surgical incision and the equal doses on post-operative days 1,2.The equal volume of normal saline was administered intravenously in group C at the same time.POD was assessed by using the Confusion Assessment Method (CAM) on post-operative days 1-3.Serum samples were collected to measure the levels of IL-6,IL-10 and S100β before the anesthesia (T0),at the end of surgery (T1) and three days after surgery (T2) by ELISA.Results The incidence of POD in group U was significantly lower than that in group C (4.3% vs.28.2%) (P<0.05).Compared with T0,the levels of serum IL-6 and IL-10 in group C at both T1 and T2 significantly increased (P<0.05).Compared with group C,serum IL-6 levels in group U decreased at both T1 and T2 (P<0.05).Compared with T0,the levels of serum S100β in group C at T1 significantly increased (P<0.05).Compared with group C,ulinastatin significantly inhibited the release of serum S100β at T1 (P<0.05).Conclusion Ulinastatin can significantly reduce the incidence of POD in elderly patients undergoing hip fracture surgery.The mechanism may involve inhibition of IL-6 and S100β in serum.