Effect Of Dexmetomidine On The Expression Of ApoE Protein And Inflammatory Factors In Patients With Esophageal Cancer With PND

Objective: To observe the effect of dexmetomidine on the expression of apoE protein and inflammatory factors TNF-α,IL-1 β and IL-6 in the whole process of PND in patients with esophageal carcinoma.Methods: A total of 120 ASAI or II patients aged > 65 were selected from the Department of Thoracic surgery of our Hospital from December 2019 to December 2020.They were divided into two groups by random number table(nasty 60):experimental group and control group.The experimental group was induced with dexmedetomidine,the concentration was 4ug /ml,and the dose of 1ug/kg was injected slowly for 15 minutes,then it was changed to 0.2-0.7ug/(kg·h)speed maintenance after15 minutes,30 min was discontinued before the end of the operation.The control group was induced with the same amount of normal saline intravenous drip.ApoE genotypes were determined by SNP sequencing and neuropsychiatric function test(CAM scale +MMSE scale)was performed one day before operation.Peripheral blood samples were taken to determine the levels of inflammatory cytokines TNF-α,IL-1β,IL-6 and apoE protein at 1 day before operation(T0),1 day after operation(T1),3 days after operation(T2)and 7 days after operation(T3).Neuropsychiatric function test was performed at 3time points after operation.Results: The total incidence of postoperative PND was 12cases(15.8%),including 2 cases(5.3%)in the experimental group and 10 cases(26.3%)in the control group(P<0.05).The carrying rate of ApoEε4 gene in all esophageal cancer patients included in the study was 10.3%.Compared with patients without ApoEε4 gene,patients with ApoEε4 gene had a significantly higher risk of PND after operation(P <0.01).The levels of TNF-α,IL-1 β and IL-6 in the experimental group decreased significantly compared with the control group on the 1st,3rd and 7th day after operation(P< 0.05),and the apoE protein decreased significantly on the 3rd and 7th day after operation(P<0.05).Compared with the non-PND group,the levels of TNF-α,IL-1β and IL-6 in the PND group were significantly higher on the 1st,3rd and 7th day after operation(P < 0.05).Conclusion: The occurrence of PND is related to the increased expression of TNF-α,IL-1β and IL-6 in serum,apoE protein in leukocytes and the carrying of ApoEε4 gene.Dexmedetomidine can reduce the concentration of TNF-α,IL-1β,IL-6 and apoE protein after operation,and reduce the occurrence of PND to some extent.