Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jan 19, 2024; 14(1): 26-35
Published online Jan 19, 2024. doi: 10.5498/wjp.v14.i1.26
Effects of ulinastatin combined with dexmedetomidine on cognitive dysfunction and emergence agitation in elderly patients who underwent total hip arthroplasty
Qi-Fan Huo, Li-Juan Zhu, Jian-Wei Guo, Yan-An Jiang, Jing Zhao
Qi-Fan Huo, Li-Juan Zhu, Jian-Wei Guo, Yan-An Jiang, Jing Zhao, Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Author contributions: Huo QF and Guo JW initiated the project and designed the experiment; Zhu LJ and Jiang YN conducted clinical data collection; Huo QF and Zhu LJ performed postoperative follow-up and recorded data; Guo JW, Jiang YN, and Zhao J conducted a number of collation and statistical analysis; Zhao J wrote the original manuscript and revised the paper; and all authors reviewed and approved the paper, and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Shaanxi Provincial People’s Hospital.
Informed consent statement: The informed consent was approved to waive.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Zhao, MM, Doctor, Department of Anesthesiology, Shaanxi Provincial People’s Hospital, No. 256 Youyi West Road, Beilin District, Xi’an 710068, Shaanxi Province, China. zhaojingsxxa@163.com
Received: August 30, 2023
Peer-review started: August 30, 2023
First decision: September 13, 2023
Revised: October 11, 2023
Accepted: December 5, 2023
Article in press: December 5, 2023
Published online: January 19, 2024
Abstract
BACKGROUND

With the continuous growth of the modern elderly population, the risk of fracture increases. Hip fracture is a common type of fracture in older people. Total hip arthroplasty (THA) has significant advantages in relieving chronic pain and promoting the recovery of hip joint function.

AIM

To investigate the effect of ulinastatin combined with dexmedetomidine (Dex) on the incidences of postoperative cognitive dysfunction (POCD) and emergence agitation in elderly patients who underwent THA.

METHODS

A total of 397 patients who underwent THA from February 2019 to August 2022. We conducted a three-year retrospective cohort study in Shaanxi Provincial People’s Hospital. Comprehensive demographic data were obtained from the electronic medical record system. We collected preoperative, intraoperative, and postoperative data. One hundred twenty-nine patients who were administered Dex during the operation were included in the Dex group. One hundred fifty patients who were intravenously injected with ulinastatin 15 min before anesthesia induction were included in the ulinastatin group. One hundred eighteen patients who were administered ulinastatin combined with Dex during the operation were included in the Dex + ulinastatin group. The patients’ perioperative conditions, hemodynamic indexes, postoperative Mini-Mental State Examination (MMSE) scores, Ramsay score, incidence of POCD, and serum inflammatory cytokines were evaluated.

RESULTS

There was a significant difference in the 24 h visual analogue scale score among the three groups, and the score in the Dex + ulinastatin group was the lowest (P < 0.05). Compared with the Dex and ulinastatin group, the MMSE scores of the Dex + ulinastatin group were significantly increased at 1 and 7 d after the operation (all P < 0.05). Compared with those in the Dex and ulinastatin groups, incidence of POCD, levels of serum inflammatory cytokines in the Dex + ulinastatin group were significantly decreased at 1 and 7 d after the operation (all P < 0.05). The observer’s assessment of the alertness/sedation score and Ramsay score of the Dex + ulinastatin group were significantly different from those of the Dex and ulinastatin groups on the first day after the operation (all P < 0.05).

CONCLUSION

Ulinastatin combined with Dex can prevent the occurrence of POCD and emergence agitation in elderly patients undergoing THA.

Keywords: Ulinastatin, Dexmedetomidine, Postoperative cognitive dysfunction, Inflammatory cytokines, Total hip arthroplasty

Core Tip: In this study, we found a significant difference in the score of 24 h visual analogue scale among the three groups, and the score in the dexmedetomidine (Dex)+ ulinastatin group was the lowest. Compared with the Dex and ulinastatin group, the Mini-Mental State Examination scores of the Dex + ulinastatin group were significantly increased at 1 and 7 d after the operation. Compared with the Dex and ulinastatin group, the incidence of postoperative cognitive dysfunction (POCD), the levels of serum inflammatory cytokines of the Dex + ulinastatin group were significantly decreased at 1 and 7 d after the operation. The observer’s assessment of the alertness/sedation score and Ramsay score of the Dex + ulinastatin group were significantly different from those of the Dex and ulinastatin groups on the first day after the operation. We observed that ulinastatin combined with dexmedetomidine can prevent the occurrence of POCD and the emergence of agitation in elderly patients undergoing total hip arthroplasty.