Effect Of Dexmedetomidine On Postoperative Delirium In Elderly Patients With Video-assisted Thoracoscope Surgery Under Cerebral Oxygen Saturation Monitoring

Object: To investigate the effect of dexmedetomidine on postoperative delirium in elderly patients with Video-assisted thoracoscope surgery and serum s-100? protein under cerebral oxygen saturation monitoring.Methods: Seventy-two patients with ASA I or?,65⁷5 years old,scheduled for elective Video-assisted thoracoscope surgery,were randomly divided into two groups?n=36,each?: Dexmedetomidine group?group D?and Control group?group C?.We used Mini Mental State Examination?Mini-Mental State,examination,MMSE?rating scale test the preoperative patients and selected the MMSE score more than 24 points.0.5?g/kg dexmedetomidine was given intravenously during 15 min in group D before anesthesia induction,then infused in 0.3⁰.5 ?g/kg/h until 30 min before the end of surgery.The same capacity of 0.9% NS was used in group C.For two groups,MAP,HR,SpO₂,ECG and cerebral oxygen saturation?rSO₂?were recorded respectively at the following times,5min before operation?T₀?,before induction of anesthesia?T₁?,before intubation?T₂?,immediately after intubation?T₃?,before one lung ventilation?T₄?,at the end of one lung ventilation?T5?,before extubation?T₆?.Blood samples were collected to determine the concentration of s-100? protein at 5 min before anesthesia,the end of operation,24 h and 48 h after operation.The postoperative delirium of patients were evaluated using the confusion assessment method Chinese Revised Edition?CAM-CR?at 1d,2d and 3d postoperative.Results: The incidence of postoperative delirium in group D was significantly lower than that in group C?P<0.05?.The content of serum s-100? protein in group D was significantly lower than that in group C at the end of operation,and 24 h after operation?P<0.05?.The levels of serum s-100? protein in two groups at the end of operation,and 48 h after operation were significantly higher than that at 5min before anesthesia?P<0.05?.The rSO₂ in two groups was significantly lower at T5 than that at T₀?P<0.05?.The MAP in group D was significantly lower than that in group C at T₃?P<0.05?,The MAP in group C was significantly higher at T₃ than that at T₀?P<0.05?;The HR in two groups was significantly higher at T₃ than that at T₀?P<0.05?.The SpO₂ had no significant difference?P>0.05?.Conclusion: Dexmedetomidine can reduce the occurrence of postoperative delirium and the level of serum s-100? protein and improve cerebral oxygen metabolism With cerebral protection in the elderly patients with Video-assisted thoracoscope surgery.