| Background and objectivesSome studies revealed that cognition impairment may occur after general aneasthesia, which result in the function disorder of brain in obtaining, reforming, storage and management of information. In addition, the decreased organic function and compensatory ability together with the strike of surgical trauma, may aggravae the occurrence of cognition disorder.Another study suggest the disorder resulted from the stress, hypoxemia and the use of analgesia and anaesthetic medicine. Consequently, finding a reliable analgesics to decrease the dose of anaesthetic medicine, to decrease the stress reaction,may be the research emphasis in the field of anesthesia. The previously used fentanyl, belonging to opioid analgesics, is necessary in balanced anesthesia, but it can result in the apoptosis of nerve cells in brain and cognition disorder. Propofol can also affect the expression of protein in brain cells, and lead to cognition disorder. Recently, dexmedetomidine was reported to have effect on the cognition disorder of old patients after general anesthesia. As a result, we study on dexmedetomidine in the current study, to clarify its intervention mechanism on the cognition disorder of old patients after anesthesia, and come up with the theoretical foundation for the clinical practice.Materials and Methods1Patients and GroupingOne hundred and fifty cases of elderly patients who received radical excision of gastric cancer under general anesthesia via abdomen in our hospital were included in the current study, among which75were male,75were female; age ranged from65to 85years old, with a mean of73.8years old; among150cases,40cases were in I period,80in II period,25in III period and5cases is in Ⅳ period. The cases were divided at random into3groups:50cases in group A (remifentanil+propofol),50cases in group B (the dose Dexmedetomidine is O.lug/kg/h) and50cases in group C (the dose Dexmedetomidine is0.2ug/kg/h). All patients were graded as Ⅰ-Ⅱ level according to the preoperative grading system of the American society of anesthesiologists (ASA), the average weight were (60±11.1)kg, all patients had no history of preoperative alcoholism、hypertension、diabetes、cerebrovascular disease、nervous system diseases and corresponding history of drugs use, and no history of internal environment serious disorders. The patients’ pain grading was recorded in detail. MMSE form and the informed consent form were filled in, and a preliminary assessment was performed. The current study was approved by the ethics committee of the first affiliated hospital of Zhengzhou university.2Anesthesia methodsGeneral anesthesia was performed in all patients by tracheal intubation, without preoperative medication in each group. The vein circuit was opened and conventional oxygen uptaking was performed for each patient. Electrocardiogram (ECG), oxyhemoglobin saturation (SpO2), non-invasive blood pressure (MAP), heart rate (HR) and partial pressure of carbon dioxide (PETCO2)were monitored. Midazolam (0.02mg/kg). Remifentanil(0.5-1ug/kg)、Propofol (1-2mg/kg) and Cisatracurium (0.1-0.15mg/kg) were intravenously injected as anesthesia induction. In Induction and maintenance period, the patient in B group were added with Dexmedetomidine0.1ug/kg/h (intravenous pumping).The patient in B group were added with Dexmedetomidine0.2ug/kg/h; Endotracheal intubation was performed after muscle relax, then the anesthesia machine was used to control breath. The anesthesia dosage was regulated according to blood pressure, heart rate and stimulus intensity of surgery Remifentanyl (0.05to0.3ug/kg/min) and propofol (3-10mg/kg/h) were used and every30to60min additional cisatracurium was used to keep20%fluctuation in MAP and HR, and maintain BIS between40and60, adjusting the breathing rate and tidal volume to maintain PETCO2between35and45mmHg. By arterial blood gas analysis, the disorder of acid-base balance and electrolyte disorders were corrected. Cisatracurium was stopped30minutes after the end of operation. When the patient presents with spontaneous breathing, clear consciousness, intensed reflex of cough and swallowing, and SpO2maintained more than95%, then pull out the endotracheal tube. As the patients are elders, the induction was performed in group B and C with the lowest concentration, and the drug concentration was regulated according to the hemodynamic changes.3Index(1) Evaluating the cognition function of patients in each group using MMSE scores.(2) Monitoring the oxygenation, heart rate and the mean arterial pressure before and after anesthesia using ECG monitor.(3) Detecting the catecholamine、IL-6and TNF-ain three groups using ELISA.4Statistical analysisStatistical analysis was performed using SPSS17.0. Measurement data was expressed using mean±standard deviation, and intra-group comparison was performed using paired t test, comparison between the groups using single one-way analysis of variance, correlation analysis performed using the Spearman correlation analysis. P<0.05is the significant difference level.Results1. In the comparison of heart rate in patients0.5h,1h,1.5h,2h after intubation and immediately after tube drawing, the values in group C were significantly lower than those in group B and A (p<0.05), and group B significantly lower than group A(p<0.05). There is no significant difference in Spo2and MAP level among the three groups (p>0.05).2. In the comparison of catecholamine、IL-6and TNF-ain patients0.5h,1h,1.5h,2h after intubation and immediately after tube drawing, the values in group C were significantly lower than those in group B and A (p<0.05), and group B significantly lower than group A(p<0.05).3. In the comparison of catecholamine、IL-6and TNF-ain patients1d,3d,5d after operation, the values in group C were significantly lower than those in group B and A (p<0.05), and group B significantly lower than group A(p<0.05).4. In the comparison of heart rate、Spo2、MAP in patients1d,3d,5d after surgery, the values in group C were significantly better than those in group B and A (p <0.05), and group B significantly better than group A(p<0.05).5. There is no significant difference among the three groups in MMSE scores after entering operation room. While, in terms of1d,3d,5d after surgery, the scores in group C were significantly better than those in group B and A (p<0.05), and group B significantly better than group A(p<0.05).6. In terms of dosage of Propofol and Remifentanil during general anesthesia, group C was significantly lower than those in group B and A(p<0.05), group B was significantly lower than group A(p<0.05).7. There is significant difference in catecholamine, IL-6, TNF-a, oxygenation, heart rate, the level of the MAP and the MMSE scores among three groups of patients(p<0.05).Conclusion1. Intravenous injection of Dexmedetomidine via vein pump can inhibit the release of catecholamine, IL-6and TNF-α in elderly patients with general anesthesia.2. Intravenous injection of Dexmedetomidine via vein pump can slow down the heart rate, increase oxygenation and stabilize the hemodynamics in old patients with general anesthesia.3. Intravenous injection of Dexmedetomidine via vein pump can reduce the dosage of intravenous general anesthesia in old patients.4. Intravenous injection of Dexmedetomidine via vein pump can decrease the occurrence of early cognition disorder in old patients after general anesthesia.5. The occurrence of early cognition disorder in old patients after general anesthesia may be correlated with the dosage of general anesthesia, heart rate, brain tissue perfusion, oxygenation, catdcholamine, IL-6and TNF-a. |
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