| Objective To observe and evaluate the perioperative effects of ulinastatin on perioperative cognitive impairment of neurological function(PND)in patients undergoing heart valve surgery,to study the association between postoperative cognitive impairment and different inflammatory factors in the body,and to explore the potential protective mechanism of brain.Methods A total of 80 patients were selected for elective heart valve replacement in the High-tech Section of the First Affiliated Hospital of Anhui Medical University,aged 45-75 years old,ASA classifications I-III.The patients were randomly assigned to two groups,an experimental group(group U,n=40)and a control group(group N,n=40),by a randomised double-blind procedure.All patients were given no drugs before entering the operating theatre in accordance with the relevant experimental requirements,and We maintain anesthesia intraoperatively using intravenous and inhalation anesthesia.In the experimental group,ulinastatin was injected with 10,000 U/kg diluted to 50 ml,and the infusion speed was 100ml/h micropump input;in the control group,normal saline was injected with 50 ml,and the infusion speed was 100ml/h micropump input.The time of infusion in both groups was immediately after induction of general anesthesia on the day of surgery(T0)and at eight o’clock in the morning from day 1 to day 7 postoperatively(T1-T7).In both groups,sex,age,height,weight,cardiac function classification,ASA classification,duration of surgery,duration of CPB,postoperative ICU stay and length of hospital stay were recorded.The Simple Mental State Examination(MMSE)and the Montreal Cognitive Assessment(Mo CA)scales were used one day before surgery to check cognitive function in both groups of patients,and the cognitive function of the 2groups was assessed using the Montreal Cognitive Assessment Scale(Mo CA)momentarily on postoperative day 3(D1)and postoperative day 7(D7).Venous blood samples were collected from patients before induction of general anaesthesia(D0),on postoperative day 1(D1),postoperative day 3(D3)and postoperative day 7(D7).After the blood was processed by cryostasis and centrifugation in a centrifuge,the supernatant was obtained and stored in a low temperature freezer at-80°C.The inflammatory factors tumour necrosis factor-α(TNF-α),interleukin-6(IL-6)and plasma S100β protein were monitored in both groups by enzyme-linked immunosorbent assay(ELISA)to observe and determine postoperative cognitive function changes of the patients,and to compare whether there is a difference in outcome between the two groups of patients.Results There was no statistically significant difference between the two groups in terms of general information and basic conditions such as age,gender,height,weight,NYHA classification,ASA classification,operative time,CPB time,ICU stay and postoperative hospital stay(P > 0.05).The preoperative MMSE was 26.38 ± 0.71 in group U and 26.76± 0.97 in group N,there was no statistically significant difference between the groups(P > 0.05).Mo CA scores were lower in both groups at the D3 and D7 moments compared to the day before surgery(P < 0.05).The Mo CA score 1 day before surgery was26.43±1.04 in group U and 26.69±1.31 in group N.The difference between groups was not statistically significant(P > 0.05).The Mo CA score 3 days after surgery was24.57±1.24 in group U and 22.03±1.17 in group N.There was a statistically significant difference between groups U and N(P < 0.05).8 patients in the U group and 14 patients in the N group showed cognitive dysfunction at the moment of D3.The Mo CA score at 7days postoperatively was 25.71 ± 1.73 in group U and 24.36 ± 1.45 in group N,there was a statistically significant difference in the results between the two groups(P < 0.05),with6 patients in the U group and 13 patients in the N group experiencing cognitive dysfunction at the moment of D7.TNF-α,IL-6 and S100β were at their lowest values 1day before surgery and their concentrations were higher at 1 day after surgery and 3 days after surgery,the results were statistically significantly different(P < 0.05).Compared with the experimental group,the concentrations of TNF-α,IL-6 and S100β in group N at1 and 3 days after surgery were significantly increased,with statistical significance(P <0.05).Conclusion After undergoing heart valve replacement,a large amount of inflammatory factors are released in the body,promoting a systemic inflammatory response,resulting in increased levels of IL-6,inflammatory factor TNF-α and serum S100β protein levels,which significantly increases the incidence of postoperative cognitive dysfunction in patients.The application of ulinastatin reduces the levels of inflammatory factors in the body,thus reducing to some extent the incidence of PND in patients undergoing heart valve replacement surgery. |
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