Effects Of Stellate Ganglion Block Combined With Dexmedetomidine On Postoperative Cognitive Impairment In Elderly Patients With Electroprostatectomy

Objective To investigate the effects of stellate Ganglion block（SGB）combined with Dexmedetomidine（Dex）on postoperative neurocognitive dysfunction in elderly patients undergoing electroresection of prostatic hyperplasia.Methods Ninety-eight patients,aged 65 to 85 years,were randomly divided into two groups（49 patients in each group）:dexmedetomidine group（D group）and dexmedetomidine combined with ultrasound-guided staphylococcal ganglia block group（S group）.In the combined group（S group）,ultrasound-guided stellate ganglion block was performed on the right neck before anesthesia induction,and 8 m L ropivacaine hydrochloride diluted to 0.375%was injected.Dexmedetomidine group（D group）and combined group（S group）were injected with 1ug/kg Dexmedetomidine hydrochloride injection by microinjection pump for 10min as its load.After 10min of continuous injection by micropump,infusion parameters of the micropump were adjusted to maintain infusion at a rate of 0.3ug/kg/h.The duration was 30 minutes before the end of surgery.After operation,patients in S group and D group were treated with conventional self-controlled intravenous analgesia.Heart rate（HR）,mean arterial blood pressure（MAP）and heart rate（HR）of patients in the combined group（S group）and dexmedetomidine group（D group）were recorded at the time of entering the operating room（T₀）,5min（T₁）,10min（T₂）,30min（T₃）after stellate ganglion block under ultrasound guidance,and at the end of surgery（T₄）.BIS and other data,we monitored,observed and recorded the local brain oxygen saturation（r SO ₂）at the above time points in a non-invasive and continuous manner using near-infrared spectroscopy.Venous blood was collected 15min before induction of anesthesia（T₀）,30min after operation（T₁）,and at the end of operation（T₂）,respectively,to detect the indicators of inflammatory factors（TNF-α,IL-6,IL-2）.Mini-mental State Examination（MMSE）scores of patients in the combined group（S group）and dexmedetomidine group（D group）on the day before surgery,the day after surgery and the day after surgery were recorded.The incidence of POCD and postoperative complications were analyzed.Results The mean arterial blood pressure at T_1-3in the combined S group was significantly lower than that in the dexmedetomidine group（P<0.05）;Two groups of patients in the operating room when local cerebral oxygen saturation（r SO₂）comparison results show that this difference is not statistically significant,but in under the guidance of ultrasound on the right side of the neck of stellate ganglion block after each point in time the joint group of local cerebral oxygen saturation（r SO ₂）monitoring data showed that is higher than the right microphones set group（D group）（P<0.05）;Compared with t₀,the levels of inflammatory indexes IL-6 and TNF-αin both groups were significantly increased at t₁and t₂,while the levels of inflammatory indexes IL-2 were significantly decreased（P<0.05）;Compared with dexmedetomidine group（D group）,IL-6 and TNF-αlevels in the combined group were significantly lower than those in the dexmedetomidine group（D group）at 30min after surgery（t₁）and at the end of surgery（t₂）,while IL-2 levels were significantly higher than those in the dexmedetomidine group（P<0.05）;On the first day and the third day after surgery,MMSE scores of patients in dexmedetomidine group（D group）were lower than those in the combined group（S group）,and the difference was statistically significant（P<0.05）.On the first day and the third day after surgery,the statistical results showed that the incidence of cognitive dysfunction in the combined group（S group）was lower than that in the dexmedetomidine group（D group）,indicating that the difference was statistically significant（P<0.05）.Conclusion Ultrasound-guided stellate ganglion block combined with dexmedetomidine,compared with dexmedetomidine alone,can improve the stability of hemodynamics,reduce inflammatory factors and increase the expression level of cerebral oxygen metabolism indexes to a certain extent.This suggests that ultrasound-guided right cervical stellate ganglion block combined with dexmedetomidine may have a positive effect on perioperative brain protection and neurocognitive function.Ultrasound-guided stellate ganglion block may enhance the postoperative neurocognitive efficacy of dexmedetomidine.