Effect Of Prophylactic Infusion Of Hypertonic Sodium Chloride Hydroxyethyl Starch 40 Injection On Postoperative Delirium With Patients Undergoing Lateral Decubitus Position Shoulder Arthroscopy

Objective:To evaluate the effect of HSH40 on postoperative delirium with patients undergoing shoulder arthroscopic surgery.Method:In this study,60 patients with shoulder arthroscopic surgery in the Third Affiliated Hospital of Hebei Medical University were selected.ASA was classified as grade I to II,aged 40 to 65 years old,with no history of chronic pain,drug allergy,antidepressant use,chronic hepatorenal insufficiency,electrolyte disorder,autoimmune disease,and cognitive impairment before operation（Mo CA≥26）.They were divided into two groups:normal saline group（N Group）and hypertonic saline group（H Group）.Blood samples were taken from peripheral arterial before liquid infusion and at 30min,1 h and 2 h(T_0-3)after infusion.To avoid electrolyte disorder,1 ml of arterial blood was analyzed for blood gas and the level of K⁺、Na⁺and Ca²⁺were measured in the peripheral arterial.And the concentrations of S-100βprotein、IL-6、IL-1β、IL-10、TNF-αin serum were measured by enzyme-linked immunosorbent assay.The values of MAP and r SO₂ and the occurrence of delirium within 3 days after operation were recorded.Results:Compared with T₀,the level of K⁺was decreased and Na⁺was increased in group H at T_1,2（P<0.05）,but there was no significant difference in the parameters mentioned above in group N（P>0.05）,MAP and r SO₂ were decreased at T_1,2,the concentration of S-100βprotein、IL-6、IL-1β、TNF-αwere increased and IL-10 was decreased at T_2,3 in two groups（P<0.05）;compared with group N,the level of K⁺was decreased and Na⁺wasincreased,MAP and r SO₂ were increased at T_1,2,the concentration of S-100βprotein、IL-6、IL-1β、TNF-αwere decreased and IL-10 was increased at T_2,3,the incidence of delirium was decreased in group H（P<0.05）.Conclusion:Prophylactic infusion HSH40 can reduce the incidence of postoperative delirium in patients with lateral decubitus position shoulder arthroscopic surgery,and its mechanism may be related to regulating the secretion of inflammatory factors and increasing regional cerebral oxygen saturation.