The Impact Of Different Anesthetic Methods On Stress Reaction Of Perioperative Period And Postoperative Cognitive Dysfunction In Patients With Diabetic Foot Surgery

Objective: To investigate the impact of different anesthesia methods on stress reaction of perioperative period and postoperative cognitive dysfunction in patients with small diabetic foot amputation surgery,and in order to provide the theoretical basis for the selection of anesthesia in patients with diabetic foot surgery.Methods: A total of 60 patients,the American Society of Anesthesiologists Physical?ASA?status II or III,undergoing elective diabetic foot surgeries were randomized into laryngeal mask anesthesia group?Group Q?with 30 cases and nerve block group?Group Z?with 28 cases?two incomplete block were eliminated?.Group Q received loading dose of intravenous pump infusion of dexmedetomidine 1ug/kg for10 min before anesthesia?followed by 2-4ug/kg/h until the end of operation?,and induced for anesthesia by the etomidate 0.05-0.2mg/kg,fentanyl 3ug/kg,and propofol 1-2mg/kg.Then an appropriate LMA double tube laryngeal mask was put into the patient's oral cavity for keeping their spontaneous breathing and dezocine5 mg was administered by intravenous injection before surgery,and propofol 4 to12mg/?kg * h?was pumped until the end of operation according to the depth of anesthesia monitoring?NI between 40 and 60?.Group Z received ultrasonic guided nerve block with 0.4% ropivacaine 20 ml injection around the sciatic nerve in lateral popliteal fossa and femoral nerve at the side of sick respectively.The heart rate?HR?,blood pressure?MAP?and pulse oxygen saturation?SPO2?were recorded at first day before operation?T₀?,begin of operation?T₁?,end of operation?T₂?.The blood glucose was recorded at first day before operation?T₀?,end of operation?T₂?,6h after operation?T6?.VAS pain score was recorded at first day before operation?T₀?,end of anesthesia?T3?,2h after operation?T4?,4h after operation?T5?,8h after operation?T7?24h after operation?T9?.The Mini Mental Exam?MMSE?Form was recorded at first day before operation?T₀?,end of anesthesia?T3?,first day after operation?T9?,3th day after operation?T₁1?,5th day after operation?T₁2?,7th day after operation?T₁3?.The expression of TNF alpha,IL-6,ACTH,s-100 beta and NSE were recorded at first day before operation?T₀?,end of operation?T₂?,12 h after operation?T8?,24 h after operation?T9?,48 h after operation?T₁0?.And when the VAS score was more than 7,dezocine 5mg was administered by single intramuscular injection.Compared with the preoperative MMSE score than 1,the postoperative cognitive dysfunction was occurred.The number of administered dezocine for additional analgesia and postoperative cognitive dysfunction were observed after operation.Results:1.At T₀,there was no statistically significant difference in all aspects between the two groups?P>0.05?.2.At T₂,the heart rate and mean arterial in group Q were lower than that of group Z?P < 0.05?.3.At T₀ T₂,there was no statistically significant difference in pulse oxygen saturation between the two groups?P>0.05?.4.At T₂,the blood glucose in group Q was higher than that of group Z?P<0.05?.5.At T3 to T5 and T7,the VAS score in group Q were higher than that of group Z?P < 0.05?.6.The probability of additional administered relieve pain with dezocine in group Q was higher than that of group Z?P <0.05?.7.At T8 T₁0,the expression of TNF alpha and IL-6 in group Q were higher than group Z?P < 0.05?.8.At T₂,T8^T₁0,the level of ACTH in group Q was higher than group Z.?P <0.05?.9.At T3,T9,T₁1 T₁3,there was no statistically significant difference in MMSE score between the two groups?P> 0.05?.10.At T₂ and T8,the expression of s-100 beta in group Q was higher than group Z?P < 0.05?.11.At T₂,T8 and T9,the expression of NSE in group Q was higher than group Z?P < 0.05?.Conclusion:1.In terms of circulatory fuction stability,the anesthetic method of group Z is better than that of group Q.2.In terms of the incidence of postoperation pain,the anesthetic method of group Z is less than that of group Q.3.In terms of stress reaction,the anesthetic method of group Z can reduce the level of stress reaction.4.There is no difference in the cognitive functin of patients with diabetic foot surgery.5.In general,the anesthetic method of group Z is better than that of group Q.