Effect of Ulinastatin Combined With Dexmedetomidine on Postoperative Cognitive Dysfunction in Patients Who Underwent Cardiac Surgery

Abstract

Background: Recent studies have shown that early diagnosis and intervention promote the patient's good prognosis. For patients who underwent cardiac surgery and require extracorporeal circulation support, the incidence of postoperative cognitive dysfunction (POCD) is higher than in other types of surgery due to greater changes in brain perfusion compared with normal physiological conditions. Recent studies have confirmed that the use of ulinastatin or dexmedetomidine in the perioperative period effectively reduces the incidence of POCD. In this study, ulinastatin was combined with dexmedetomidine to assess whether the combination of the two drugs could reduce the incidence of POCD. Methods: One hundred and eighty patients with heart valve replacement surgery undergoing cardiopulmonary bypass from August 2017 to December 2018 were enrolled, with age 60-80 years, American Society of Anesthesiologists (ASA) grades I-III, education level above elementary school, and either gender. According to the random number table method, patients were grouped into ulinastatin + dexmedetomidine (U+D) group, ulinastatin (U) group, dexmedetomidine (D) group, and normal saline (N) control group. Group U was pumped 20,000 UI/kg immediately after induction and the first day after surgery, group D continued to pump 0.4 µg/kg/h from induction to 2 h before extubation, group U+D dexmedetomidine 0.4 µg/kg/h + ulinastatin 20,000 UI/kg, and group N equal volume of physiological saline. The patients were enrolled with Mini-Mental State Examination (MMSE) before surgery. The cognitive function was assessed by Montreal Cognitive Assessment (MoCA) on the first day before surgery and on the seventh day after surgery. Inflammatory factors, such as S100β protein, interleukin (IL)-6, matrix metalloproteinase (MMP)-9, and tumor necrosis factor (TNF)-α, were detected in peripheral blood before anesthesia (T0), immediately after surgery (T1), and immediately after extubation (T2). Results: One hundred and fifty-four patients enrolled in this study. Compared with group N, the incidence of POCD in group U+D was the lowest (P < 0.05), followed by group U and group D. Group U+D had the lowest concentration of inflammatory factors at the T1 and T2 time points, followed by group U and group D. Zhou et al. Ulinastatin and Dexmedetomidine for Postoperative Cognitive Dysfunction Conclusions: Both ulinastatin and dexmedetomidine can reduce the perioperative inflammatory response and the incidence of POCD in patients with heart valve surgery, and their combination can better reduce the incidence of POCD.

WITHDRAWN: Effectiveness of Intraoperative Dexmedetomidine on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial

“…POCD was diagnosed by Z-score in a comprehensive test scale recommended by the International Study of POCD (ISPOCD) [14]. Patients were de ned as having POCD when Z-score were above 1.96 using cross-reference [15].…”

“…Furthermore, we combined neurocognitive score and IL-6 simultaneously. We used the recommended tests by ISPOCD in the present study and calculated Z-score above 1.96 to diagnose POCD [15]. This method avoided oor or ceiling effects.…”

Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

“…Specific to our study design, four studies concentrated on cardiac valve surgery ( 24 , 26 , 28 , 34 ), 15 studies included combined CABG and valve surgeries ( 10 , 16 – 23 , 25 , 27 , 29 , 31 , 33 , 37 ), and the remaining five studies related to CABG ( 15 , 30 , 32 , 35 , 36 ). Dexmedetomidine was administered during the intraoperative period in six studies ( 26 – 29 , 31 , 35 ), the perioperative period in eight studies ( 10 , 15 , 23 – 25 , 33 , 34 , 37 ), and the other 10 studies during the postoperative period ( 16 – 22 , 30 , 32 , 36 ). CAM/CAM-ICU was used in nine studies as the diagnostic tool for POD ( 16 , 18 , 20 , 23 , 25 , 30 – 33 ) and five studies used RASS ( 10 , 17 , 19 , 21 , 22 ).…”

Dexmedetomidine might improve postoperative cognitive dysfunction in older patients undergoing pulmonary surgery

“…Dexmedetomidine is an α 2 -adrenoreceptor agonist that calms, reduces pain, and inhibits the activity of the sympathetic nervous system, but also can inhibit the in ammatory response and stress response, reduce neuronal toxicity and apoptosis, and promote brain protection through synapse formation and neurotrophic nutrition 30 . Zeng and colleagues showed that dexmedetomidine can affect expression of proin ammatory factors and reduce the in ammatory response in blood vessels by activating the corresponding signaling pathways 31 .…”