The Comparative Study Of The Prevention Of Postoperative Delirium After Gastric Cancer Surgery By Using Dexmedetomidine Combined With Xuebijing

ObjectiveFor investigating the influence of using Dexmedetomidine combined with Xuebijing on the incidence rate of postoperative delirium and traumatic inflammatory response after having laparoscopic gastric cancer surgery, and providing a reference for the Dexmedetomidine clinical rational drug use, the occurrence of postoperative delirium after using Dexmedetomidine combined with Xuebijing during the anesthesia was observed, meanwhile Patients’vital signs parameters were recorded, and changes in plasma inflammatory cytokines and markers of central nervous system damage were also determinated.Methods80 patients undergoing general anesthesia gastric cancer peritoneoscope surgery were randomly divided into 4 groups:Routine Anesthesia Group (Group C), Dexmedetomidine Group (Group D), Xuebijing Group (Group X), Dexmedetomidine combined with Xuebijing Group (Group DX). Intervening Measure: giving DEX 1. Oug/kg to the patients from Group D during anesthesia induction; giving Xuebijing 50ml to the patients from Group X during operation; giving DEX 1. Oug/kg during anesthesia induction and giving Xuebijing 50ml during operation to the patients from Group DX; giving same amount of normal saline to the patients from Group C. Preoperative, intraoperative (after skin incision 1h) and postoperative blood of patients from these 4 groups was extracted for gas analysis respectively. Vital signs, narcotrend, drug use, fluid input volume, bleeding volume, urine volume, anesthesia time, extubation time and leaving time were recorded during operation. Collect the Peripheral Blood Leukocyte Count before operation and 1st day after it. Serum was separated from venous blood which extracted before, after and 1st day after the operation, and was stored at-20℃ for detecting IL-10 and S100β. Moreover, CAM-ICU evaluation was implemented on the same day of the operation, and CAM-CR evaluation was implemented on day 1 and day 2 after the operation.ResultsThere was no significant differences in gender, age, height, weight, ASA classification and underlying disease condition etc. of the 4 groups (P>0.05). There was also no significant differences among 4 groups in anesthetic dosage, anesthesia time, volume of fluid input and blood loss (P>0.05). However, there was statistical significance in urine volume (P<0.05):Group D had the highest volume, and Group C had the lowest one. There was still no significant differences in nitroglycerin and atropine needs of the 4 groups (P>0.05). Yet the dosage of aramine did have statistical significance (P<0.05), and Group X and Group DX had a higher dosage.There were statistical differences in comparing the periphery white blood count, neutrophilic granulocyte percentage, neutrophilic granulocyte count, lymphocyte count and body temperature of the 4 groups before operation with these after operation (P<0.05), and so was the monocyte count of Group D (P<0.05). But there were no differences in comparing the counts mutually among the 4 groups (P>0.05). In blood gas analysis, there was no statistical significance in comparing the data mutually among the 4 groups (P>0.05), except for the Na at time T3. The blood pressure of the patients from 4 groups had dropped dramatically after dose (P<0.05), and not recovered until 10 minutes after the operation started (p>0.05). And there were no significant differences in MAP values when comparing it among the 4 groups (P>0.05). There were statistical differences in HR and CI values when comparing them among the 4 groups at the time before and 3 minutes after giving intubation, and during the operation as well (P<0.05). Yet there were not statistical differences while doing the compare with the values above at the rest of the time points (P>0.05). There were no significant differences in the NI values at all time points (P>0.05), and neither in extubation time, leaving time and duration after operation (P>0.05).The postoperative delirium did not happen according to the results of CAM-CR evaluations given to the patients 1 day and 2 days after operation respectively (CAM-CR results< 22). And there were no significant differences in comparing the CAM-CR evaluation results within each group.The comparation of CAM-ICU evaluation results (same day after operation) among different groups showed statistical significance (P<0.05), and there were 9 patients had delirium after operation at the same day:Routine Anesthesia Group had 6 (30%), Dexmedetomidine Group had 0 (0%), Xuebijing Group had 2 (10%), Dexmedetomidine combined with Xuebijing Group had 1 (5%). Compared with Routine Anesthesia Group, there were significant reduction on the incidence rate of postoperative delirium for Dexmedetomidine Group and Dexmedetomidine combined with Xuebijing Group (P<0.05).Possibly due to inappropriate conservation or detection on the specimens, IL-1β and S100β results were erratic in this research, and they could not illustrate the situation of inflammatory response and central lesion precisely.ConclusionIn this research, there were 9 patients had delirium after operation, and the incidence rate was 11.25%. There was a significant decrease on the incidence rate of Postoperative Delirium for Dexmedetomidine Group and Dexmedetomidine combined with Xuebijing Group, showed the usage of Dexmedetomidine in laparoscopic gastric cancer surgery could reduce the incidence rate of Postoperative Delirium. Compared with the Routine Anesthesia Group, the Xuebijing Group had no significant difference on the incidence rate of Postoperative Delirium, showed the usage of Xuebijing could hardly reduce the incidence rate of Postoperative Delirium for such patients.