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

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.