Effect Of Dexmedetomidine Combined With Ulinastatin On Postoperative Delirium In Elderly Patients Undergoing Resection Of Gastrointestinal Tumor

Objective:To investigate the effect of dexmedetomidine combined with ulinastatin on postoperative delirium after laparoscopic gastrointestinal tumor resection in elderly patients.Methods:September 2015 ~ January 2016 in Deyang City People’s Hospital elective laparoscopic gastrointestinal tumor resection(radical gastrectomy,colorectal cancer radical surgery)patients with 180 cases,sex is not limited,aged 65-80 years old,ASA grading II or III.Patients were randomly divided into 4 groups: 1 control group(n=45),2 dexmedetomidine group(group Dex n=45),3 ulinastatin group(group Uti n=45),4 dexmedetomidine + ulinastatin group(group Dex +Uti n=45).Patients in the group Dex were given a loading dosage of dexmedetomidine(0.5μg /kg)intravenously in 15 min before the induction of general anesthesia and then continued at 0.3μg/kg/h for 40 minutes before the end of the operation.Patients in the group Uti,were given a loading dosage of ulinastatin(10000U/kg)intravenously in 20 min.In group Dex +Uti,dexmedetomidine and ulinastatin were administered according to Group Dex and Group Uti,respectively.Patients in the control group were given 0.9% saline solution.Anesthesia was induced with sufentanil(0.3-0.50μg/kg),midazolam(0.05mg/kg),e t o m i d a t e(0.1-0.2 m g / k g)a n d c i s-a t r a c u r i u m(0.2mg/kg).The patients were mechanically ventilated and end-tidal CO2 was held constant between 30-40 mmHg.Anesthesia was maintained with TCI of propofol(target plasma concentration,2-3μg/ml),continuous infusion of remifentanil(0.10-0.20μg/kg/min)and cis-atracurium intermittently as required.During the investigation,HR,electrocardiography(ECG),MAP,SpO2 and PetCO2 were continuously monitored.The depth of anesthesia was monitored and recorded by a Narcotrend Index(NTI)sensor applied to the forehead.The anesthesia was guided to reach a NTI value of 45-55.At the end of the procedure,each patient received patient controlled venous analgesia(PCIA).The operation time,intraoperative blood loss,urine output and fluid volume were recorded.Before the time of administered dexmedetomidine or ulinastatin,intubation immediately,extubation immediately,MAP and HR were record and compared.The confusion assessment method Chinese reversion(CAM-CR)was used to screen POD on preoperative days 1,postoperative days 1,2 and 3.At the time of preoperative 1d(Ty),postoperative 1d(T1),2d(T2),3d(T3),the concentration of dopamine(DA),adrenaline(AD),norepinephrine(NE)were detected.Results: 1)There were no significant differences in demographics,operative time,blood loss,infusion volume,urine output and the scale of CAM-CR before operation among the 4 groups(p>0.05)2)MAP and HR in group Dex +Uti and group Dex were lower than that in group Uti and control group during intubation and extubation(p<0.05).Among the 4 groups,The difference were not statistically significant in the incidence of myocardial ischemia(p >0.05).3)The levels of DA,AD and NE in the control group and group Uti at T0~T3 significantly elevated than that at Ty(p<0.05);the levels of DA,AD in group Dex +Uti and group Dex significantly elevated than that at Ty(p<0.05).The levels of DA,AD and NE in group Dex +Uti and group Dex were significantly reduced compared with those in the control group(p<0.05);there were no statistical difference between the control group and group Uti in the levels of DA,AD and NE(p >0.05).Compared with group Dex,the levels of DA,AD and NE in group Dex +Uti were no statistical difference(p >0.05).4)Five patients in the group Dex,8 patients in the group Uti,3 patients in the group Dex +Uti and 17 patients in the control group displayed postoperative delirium(POD).Compared with the control group,the incidence of POD was significantly reduced in the group Dex,group Uti and group Dex +Uti.Among the 3 groups(Dex,Uti,Dex +Uti),the difference were not statistically significant in the incidence of POD(p>0.05).Conclusions: 1)Dexmedetomidine combined anesthesia can inhibit postoperative dopamine,adrenaline and norepinephrine release,and reduce the rate of POD in elderly patients undergoing laparoscopic surgery for gastrointestinal tumor.2)The administration of ulinastatin(10000U/kg)can reduce the incidence of delirium after laparoscopic gastrointestinal tumor resection in elderly patients.3)Compare with the administration of ulinastatin or dexmedetomidine alone,combined application of dexmedetomidine and ulinastatin does not reduce the incidence of POD.