| ObjectiveIn order to investigate the protective effcet of different doses of dexmedetomidine on the kind of elderly patients with hip replacement surgery, to provide a reference for the dexmedetomidine clinical rational drug use,elderly patients given different doses of the dexmedetomidine(Dex) were observed on the impact of postoperative cognitive function. Patients’vital signs parameters were also recorded and changes in plasma inflammatory cytokines and markers of central nervous system damage were determinated.Methods80elderly patients under going spinal anesthesiain hip replacement surgery were randomly divided into4groups:control group(DO group), Dex0. Sμg·kg-1·h-1group (D1group),0.75μg·kg-1·h-1group (D2group) and1.0μg·kg-1·h-1group (D3group). Venous blood under test extracted preoperative, intraopera-tive (after skin incision lh) and postoperative respectively was separated and stored at-20℃to detect TNF-α、IL-10, NSE and S100β. Montreal cognitive function assessment was conducted Id preoperative,1d and7d postoperative. Narcotrengd value, Ramsay score and vital signs were recorded intraoperative.ResultsAmong four groups, there were no significant difference of patient’s age, height, weight, body mass index, gender, ASA classification and complica-tions (P>0.05). Hypertension, diabetes, abnormal electrocardiogram, COPD and other underlying diseases contrasted also had no significant difference(P>0.05). And the plane of anesthesia, operative time, intraoperative fluid volume, bleeding volume and urine output had no significant difference too(P>0.05). And it was the same as the preoperative use of vasopressors and atropine(P> 0.05), while the dose of the two used by four groups increased with the dexmedetomidine dose increasesing(P<0.05) and the exmedetomidine doses of four groups were0,0.75,1.12,1.55μg/kg respectively (P<0.05).In the process of surgical anesthesia, the lowest HR averages of four groups (DO, D1, D2, D3) were67.7,63.2,62.0and64.3times/min respectively (P>0.05), but the time to the minimum value of the HR DO group was significantly shorter than the other three groups(P<0.05), respectively37.7,69.5,65.0and64.0min. The reduction amplitude of HR values and percentages increased with the increasing of Dex applications dose(P<0.05) and the HR reducement magnitude of the four groups were16.5%,21.5%,26.3%and27.9%respectively. Anesthesia during surgery, DO SBP lowest value was significantly higher than the other three groups(P<0.05),while the lowest was D3group. The magnitude of blood pressure reduction and percentage of D2、D3were significantly greater than the Dl group and the control group(P<0.05). Oxygen saturation of the four groups of patients showed no significant difference (P<0.05).Among the three groups, the onset of sedation time decreased with the increasing of dexmedetomidine dosing speed. D1、D2、D3group was significantly shorter than the control group (P<0.05). The NT vally reflecting the depth of sedation reduced while the dexmedetomidine dose increasing. there was significant difference (P<0.05) between D2and D3group with D1group also. The time types of NT≤80and Ramsay≥4reflecting the duration of sedation prolonged while the dexmedetomidine dose increasing, and the sedation time of D3was significantly longer than the DO and D1group(P<0.05).Compared with the preoperative period, the value of WBC and neutrophil were different significantly in surgery and postoperative one day (P<0.05), however, no difference showed between the groups (P>0.05). The number of lymphocytes and monocytes postoperative Id of D3group was higher compared with D0、D2(P<0.05).There was no significant difference showing among the score of MoCA of each groups preoperative1day (P>0.05), but,One and seven days after surgery,the score of MoCA D3was the highest while and the difference is significant(P<0.05). The number of cases of the cognitive score decreased between preoperative and postoperative Id in each group showed a significant difference in comparison (P<0.05). However, the cases of the cognitive function score decreased between preoperative and postoperative7d in each group showed no decline statistically significant difference (P>0.05).There was a significant difference showing among IL-10concentrations of each groups in preoperative、during and after surgery (P<0.05), and D3was the highest one during and after surgery. NSE、S100βconcentrations in patients in each group was no significant difference(P>0.05) preoperative but gradually increaded while in surgery and postoperative significantly(P<0.05), while DO group increasing more than D2and D3group(P<0.05). TNF-a was not detected result.ConclusionIn the hip replacement surgery of elderly patients, applications of Dex produced dose-related effects of sedation depth and duration and that postoperative cognitive function also have been improved and postoperative brain damage markers NSE and S100β plasma levels could be reduced too, which indicated that intraoperative intravenous infusion Dex showde a protective effect of brain, and of which1.0μg·kg-1·h-1infusion effect was the most obvious. |
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