| Objective: Explore and discuss the degree of nerve injury with spinal surgery and clinical application of different doses of dexmedetomidine for neuroprotection in elderly patients.Reveal the factors influencing the formation of early cognitive impairment after operation and the drug therapy in the elderly patients with spinal surgery.Methods:There are 120 patients whose ages were over 65 years old and the BMI were between 19.0 and 25.1 receiving general anesthesia and undergoing selective spinal surgery from September 2015 to December 2016 at the Laoshan District of the Affiliated Hospital of Qingdao University.They were enrolled and divided into groups with different doses of dexmedetomidine(D1 group,D2 group,and D3 group)and the control group(C group),using a random number table.The patients in the D1 group,D2 group,and D3 group continued to pump dexmedetomidine at a rate of 0.5?g/(kg·h)15 minutes before induction of anesthesia.And the patients in the C group were given intravenous pumping of an equal volume of normal saline for 15 minutes too.Anesthesia induction and tracheal intubation for patients after pump injection.Subsequently,patients in the D1 group,D2 group and D3 group received continuous intravenous infusion of 0.1,0.3,0.5 ?g/(kg·h)until the end of operation.The patients in the C group received saline infusion of equal volume until the end of operation.Before induction of anesthesia(T0)and postoperative 24 h,48h,72h(T1,T2,T3),the median venous blood of the forearm was extracted respectively.Enzyme linked immunosorbent assay(ELISA)was used to detect the levels of S-100 beta protein and the concentration of neuron specific enolase in the serum of patients.The cognitive function of the patients was measured by the Mini-Mental State Examination(MMSE)scale at the afternoon of the day before and after the operation 72 h.Results: The levels of serum S-100?in D1 group,D2 group and D3 group were decreased(F=3.288~12.468,P<0.05)at the time points of T1,T2 and T3 compared with the C group and the levels of serum S-100?was significantly decreased at the time of T2;Compared with T0 time point,the levels of serum S-100?in D1 group,D2 group and D3 group were all increased(F=43.457~97.541,P<0.05)at the time points of T1,T2 and T3,and the levels of serum S-100?increased the least in the D3 group.Compared with group C,the levels of serum NSE in D1 group,D2 group and D3 group were decreased(F=3.275~3.168,P<0.05)at the time points of T1,T2 and T3,and the levels of serum NSE was significantly decreased at the time of T2;Compared with T0 time point,the levels of NSE in D1 group,D2 group and D3 group were all increased(F=44.201~123.174,P<0.05)at the time points of T1,T2 and T3,and the levels of serum NSE increased the least in the D3 group.Compared with group C,the incidence of 72 h POCD in D1 group,D2 group and D3 group decreased after operation,and there was a significant difference between D3 group and C group(?2=4.320,P<0.05);There was no significant difference between the 2-2 groups of D1 group,D2 group and D3 group(P>0.05);There was no significant difference in the incidence of hypotension and bradycardia after operation(P >0.05)in the 4 groups.Conclusion: The proportion of elderly patients with cognitive impairment in the early stage after spinal surgery is increasing year by year in overall spinal surgery patients.It is found that spinal surgery can cause nerve damage by detecting serum samples.Intraoperative dexmedetomidin is used to relieve the corresponding neuropsychiatric symptoms.Dexmedetomidine,a widely used new sedative and analgesic anesthetic drug,can effectively reduce the incidence of neurological impairment and cognitive dysfunction in elderly patients after spinal surgery,and it is the most suitable dosage in group D3. |
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