Effect Of Dexmedetomidine On Delirium After Liver Tumor Resection In Elderly Patients With Sleep Disorders

Object:To investigate the effect of dexmedetomidine on delirium after liver tumor resection in elderly patients with sleep disorder(SD).Methods:Choose elective hepatectomy under general anesthesia of patients,aged 65 or higher,BMI 18 to 25 kg/m2,ASA Ⅰ-Ⅱ level,Total diameter of liver tumor ≤5cm.A total of 80 patients with sleep disorders(PSQI≥7 points)were selected according to the Pittsburgh Sleep Quality Index(PSQI)before surgery,and were divided into the sleep disorders group(SD group)and the sleep disorders+dexmedetomidine group(DEX group)by random number table method,with 40 patients in each group.Forty normal sleep patients(PSQI<7 points)were selected as normal sleep group(group C).The three groups were treated with etomidate emulsion injection,sufentanil citrate and rocuronium bromide for anesthesia induction.Propofol medium/long chain fat emulsion injection and remifentanil were used to maintain anesthesia,and BIS was maintained at 40-60 during the operation.The intraoperative use of etomidate emulsion injection,sufentanil citrate and remifentanil were recorded.Duration of anesthesia,duration of operation,duration of stay in PACU and postoperative hospital stay were recorded.MMSE and visual analogue scale(VAS)scores were recorded 2 h,1,3,5,and 7 days before surgery,and delirium was assessed by fuzzy consciousness scale(CAM).QOR-40 scores were recorded at 1,2,3,5,and 7 days postoperatively.The plasma levels of IL-6 and S100β were determined by ELISA 2 hours before and 2 hours after surgery,1,3 and 5 days after surgery.The incidence of adverse reactions in three groups was recorded.Results:1.Comparison of general informationThere were no significant differences in gender,age,BMI,ASA grade,years of education,MMSE score and POD assessment among SD group,DEX group and C group(P>0.05).Preoperative PSQI scores in SD group and DEX group were significantly higher than those in C group(P<0.05).2.Comparison of intraoperative drug useThere was no statistical significance in the amount of etomidate,propofol,sufentanil and remifentanil in the three groups(P>0.05).There was no statistical significance in the number of intraoperative ephedrine,methoxamine,atropine,uradil and nitroglycerin among the three groups(P>0.05).3.Comparison of operative time,time of stay in PACU and postoperative hospital stay.There was no significant difference in anesthesia time and operation time among the three groups(P>0.05).Compared with C group,the retention time of PACU in SD group and DEX group was significantly increased(P<0.05);The postoperative hospitalization time of SD group was significantly prolonged(P<0.05);Compared with SD group,the retention time of PACU and postoperative hospitalization time of DEX group were significantly shortened(P<0.05).4.Comparison of postoperative cognitive functionThere was no significant difference in preoperative MMSE scores among the three groups(P>0.05).Compared with group C,the MMSE scores of SD group and DEX patients on day 1,3,5 and 7 after surgery were significantly decreased(P<0.05);Compared with SD group,MMSE scores in DEX group were significantly increased on day 1,3,5 and 7 after surgery(P<0.05).5.Comparison of POD occurrence after surgeryCompared with group C,the total number and incidence of POD during 1-7 days after surgery in SD group and DEX group were significantly increased,and the postoperative POD duration in SD group was significantly prolonged(P<0.05).Compared with SD group,the total number of cases,incidence and duration of POD 1-7 days after surgery in DEX group were significantly decreased(P<0.05).6.Comparison of plasma IL-6 and S100β levels in patientsThere was no significant difference in plasma IL-6 and S100β concentrations between the three groups 2 hours before surgery(P>0.05).Compared with C group,plasma IL-6 and S100β concentrations in SD group and DEX group were significantly increased at 2 h,1 day,3 days and 5 days after surgery(P<0.05);Compared with SD group,plasma IL-6 and S100β concentrations in DEX group were significantly decreased 2 h,1 day,3 days and 5 days after surgery(P<0.05).7.VAS score 7 days after surgeryCompared with group C,VAS scores in SD group and DEX group were significantly increased at 2 h,1 d,2 d,3 d and 5 d after surgery(P<0.05);Compared with SD group,VAS scores in DEX group were significantly decreased at 2 h,1 d,2 d,3 d and 5 d after surgery(P<0.05).There was no significant difference in VAS scores between the three groups 7 days after surgery.8.QoR-40 score of patients 7 days after surgeryCompared with group C,QoR-40 scores in SD group and DEX patients on day 1,2,3,5 and 7 after surgery were significantly decreased(P<0.05);Compared with SD group,QoR-40 score in DEX group was significantly increased on day 1,2,3,5 and 7 after surgery(P<0.05).9.Adverse reactionsThere was no statistical significance in the incidence of adverse reactions among 3 groups(P>0.05).Conclusion:Dexmedetomidine can reduce the incidence and duration of postoperative delirium in elderly patients with preoperative sleep disorders,and provide reference for postoperative anesthesia of liver tumors in patients with preoperative sleep disorders.