Analysis Of The Curative Efficacy Of Dexmedetomidine Hydrochloride Combined With Ulnastatin In The Treatment Of Cognitive Dysfunction In The Elderly Patients With Abdominal Surgery

Objective:To investigate the effect of dexmedetomidine hydrochloride combined with ulinastatin on the postoperative inflammatory factors and cognitive dysfunction in the elderly patients undergoing abdominal surgery and its possible mechanisms.Methods:150 cases of patients who underwent open surgery in the gastroenterology,urology and hepatobiliary surgery and divided into the dexmedetomidine group,the ulinastatin group and the combined group according to the randomized regimen,with 50 patients in each group.The postoperative recovery time,effective analgesia time,number of agitation cases and postoperative cognitive dysfunction(POCD),changes of serum tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6)and S-100 protein(S100β)levels in different times:preoperative(T0),instantly after operation(T1),three hours(T2),one day(T3)and seven days(T4)after operation,simple intelligent state scale(MMSE)score before and after treatment and the occurrence of adverse reactionswere were compared between the three groups.Results:There was no significant difference in the recovery time of anesthesia among the three groups(P>0.05).The incidence of restlessness(2%)and POCD(6%)in the combined group was significantly lower than that in the dexmedetomidine group(16%,22%)and the ulinastatin group(18%,24%),and the effective analgesia time(39.14±3.53h)was significantly longer than that of the dexmedetomidine group(7.37±1.26h)and the ulinastatin group(12.24±3.64h)(P<0.05).After treatment,the levels of TNF-α,IL-6 and S100β levels in the three groups were significantly improved compared with those before treatment,and the levels of TNF-α,IL-6 and S100β in the combined group were significantly lower than those in dexmedetomidine group and ulinastatin group at all time points(P<0.05).After treatment,the MMSE score of the combined group(1 day:26.34±2.94,7 day:26.57±6.67)was significantly higher than that of the dexmedetomidine group(1 day:23.21±5.42,7day:24.57±5.23)and the Ulinastatin group(1 day:23.11±3.47,7 day:23.87±2.49)(P<0.05).The total incidence of adverse reactions in combination group was 24.00%,significantly lower than that in dexmedetomidine group(50.00%)and ulinastatin group(48.00%)(P<0.05).Conclusion:(1)Compared with dexmedetomidine hydrochloride and ulinastatin alone,dexmedetomidine hydrochloride combined with ulinastatin can more effectively prevent the emergence of restlessness and POCD.(2)Compared with dexmedetomidine hydrochloride and ulinastatin alone,dexmedetomidine hydrochloride combined with ulinastatin in the elderly patients undergoing abdominal surgery with higher safety and lower adverse reactions.(3)The mechanism of action of dexmedetomidine hydrochloride combined with ulinastatin may related with reducing the levels of TNF-α,IL-6 and S100β,inhibiting inflammation and exerting organ protection.