The Clinical Applications Of Different Does Of Dexmedetomidine And Its Effects On Postoperative Cognitive Dysfunction After Abdominal Surgery In Elder Patients

Objective:The present study was designed to observe the influence of anesthesia recovery quality,inflammatory foctor to evaluate postoperative cognitive dysfunction by using Wechsler Adult Intellgence Scale and Wechsler Memory Scale when dexmedctomidine had been used in general anesthesia in elder patients undergoing abdominal surgery.Methods:Thirty elder patients aged 75-80 years old,ASA II-III were randomized into five groups:A(propofol group),B(dexmedctomidine group),(sevo group)each group included 20 cases.Induction:intravenois midazolam 0.05mg/kg,1.5mg/kg propofol and sufentanil 0.3?g/kg,atracurium 0.8 mg/kg,then the trachea intubation and mechanical ventilation.Maintain anesthesia:vein with TCI group A pump intravenous propofol target control,maintain the plasma concentration of target 4 ng/ml,ruifentanyl 0.05-0.1?g.kg-1�min-1 and intermittent static note maintain muscle relaxant atracurium.Group B:BIgroup 10 minutes before anesthesia induction intravenous injection pump dexmedctomidine cannot totally 0.5 mg/kg,set 20 min pumping out,then in 0.2?g.kg-1�h-1 to maintain to about 30 min before the end of surgery to stop pumping.B?group 10 minutes before anesthesia induction intravenous injection pump dexmedctomidine cannot totally 0.5 mg/kg,set 20 min pumping out,then in 0.4?g.kg-1�h-1 to maintain to about 30 min before the end of surgery to stop pumping.B?group 10 minutes before anesthesia induction intravenous injection pump dexmedctomidine cannot totally 0.5 mg/kg,set 20 min pumping out,thenin 0.8?g.kg-1�h-1 to maintain to about 30 min before the end of surgery to stop pumping.The two remaining capacity such as physiological saline group.TCI propofol injection pump to maintain target plasma concentration of 2-4 ng/ml,ruifentanyl 0.05-0.1?g.kg-1�min-1 and intermittent static note maintain muscle relaxant atracurium.The application of group C sevoflurane inhaled exhale concentration 1%-3%at the end of TCI propofol injection pump to maintain target plasma concentration of 2-4 ng/ml,rui fentanyl 0.05-0.1?g.kg-1�min-1 and intermittent static note maintain muscle relaxant atracurium.In each group to maintain the BIS value of 45-55.Never put off till tomorrow what you can to pull out the endotracheal tube operation after postoperative care ward.Patients from stop drug absorption to spontaneous breathing recovery time,the open time,extubation time.Respectively before anesthesia(T0),cut the skin(T1),at the end of surgery(T2),postoperative 1 h(T3)take 2 ml,internal jugular venous blood serum IL-6,Bk,according to beta level.Using simple mental state scale(MMSE)in preoperative testing 1 day,revised wechsler adult intelligence scale(WAIS-R)and the revised wechsler memory scale(WMS-R)in preoperative and postoperative 1 day,3 days,7 days to cognitive function test,according to the international team recommended judgment standard cognitive dysfunction composite Z score method to evaluate the cognitive dysfunction.Statistics the incidence of postoperative cognitive dysfunction.Results:1.There were no significant different in the aspects of fundamental state,MMSE.2.Five groups of patients with postoperative BK,IL-6,plasma concentrations of s-100? protein were significantly higher(P<0.05),compared with preoperative and postoperative dexmedctomidine group more low propofol and sevoflurane group(P<0.05).3.Dexmedctomidine group than propofol and sevoflurane group during breathing recovery time,we used in open time,extubation time time is shorter to higher quality(P<0.05).4.Wechsler Adult Intellgence Scale into patients and Wechsler Memory Scale each individual test,associative learning,accumulating and test scores compared with preoperative visual regeneration tests difference had statistical significance(P<0.05).In each group after preoperative the poor test scores(X),in the comparison of the accumulation,associative learning,digit span a reverse test was statistically significant(P<0.05),the other has no obvious difference between the test group(P>0.05).5The POCD incidence of dexmedetomidine group was significantly lower than the control group(P<0.05).Conclusions:1.Intraoperative application dexmedetomidine can reduce the release of inflammatory mediators.2.Intraoperative application dexmedetomidine swhich can improve the quality of the patients regained consciousness.3.Intraoperative application dexmedetomidine organism can decrease the age old people is the development of early postoperative cognitive dysfunction.4.Different doses of measuring dexmedetomidine holds there were no significant differences on postoperative cognitive dysfunction.