| OBJECTIVE: This study is to investigate the effect of dexmedetomidine in ERCP examination on the postoperative cognitive function in elderly patients.METHODS: The study of this paper is based on the data from the minimal-invasive cholelithiasis surgeries of Dalian University Affiliated Zhongshan Hospital between January 2018 and December 2018.80 elderly patients with ERCP examination undergoing biliary surgery were selected as sample,and they met the following conditions: ASA grade I~III,no gender limitation,age 65 or older,and weighed 45~75kg.The 80 cases were divided equally into two parts by random,which are experimental group(dexmedetomidine group)and control group(propofol group).These patients were opened venous access and the nasal cannula was inhaled with oxygen for 3 L/min.Meanwhile,the non-invasive blood pressure(NIBP),heart rate,pulse oximetry,and ECG were routinely monitored.The anesthesia during the operations was a total intravenous anesthesia retained spontaneous breathing.Considering the experimental group,the loading dose of dexmedetomidine 0.4~0.5?g/kg was infused within 10 minutes after these patients entered the operating room.Then oxycodone 0.1 mg/kg was given immediately after the infusion.About the subsequent maintenance of anesthesia,researchers would use propofol 2mg/kg·h.By contrast,the members of control group would be injected midazolam 0.03~0.04mg/kg,oxycodone 0.1mg/kg,and propofol 2mg/kg·h(was maintained for anesthesia).The infusion of the above propofol in both groups would stop 10 minutes before the end of the operation.Throughout the operation,the observation indicators included as follows:The figures of NIBP and heart rate at the times of 80 patients entering the operating room(Ta),post-anesthesia induction(Tb),at the beginning of operating(Tc)and operating finished.(Td).Besides,the changes of mini-mental state examination scores(MMSE),peripheral venous blood IL-10 and the concentration of TNF-??S100? protein in plasma at various time points including 1 day before surgery(T0),1 day after surgery(T1),and 3 days after surgery(T2).RESULTS: There were no statistical differences in the data from age,height,weight,BMI,operative time,and intraoperative Ramsay sedation score between the treatment group and control group(P>0.05),therefore,these two groups were comparable.First of all,there were no differences in statistics in NIBP and heart rate between the two groups when entering the operating room.After induction of anesthesia and after the start of surgery,the NIBP of the experimental group was significantly higher than that of the control group(P<0.05),however,the heart rate of the treatment group was significantly lower than that of the controls(P<0.05).MMSE scores between the two groups were not statistically significant as well(P>0.05).The MMSE scores of the experimental group were significantly higher than those of the control group at 1 day and 3 days after operation(P<0.05).In addition,the MMSE scores of the two groups after operation were significantly lower than those before surgery(P< 0.05).The two groups have no statistical different in the concentration of IL-10,TNF-? and S100? protein in peripheral venous blood(P>0.05).The concentration of IL-10 in the peripheral venous blood of the treatment group was significantly higher than that of the control group 1 day after surgery while TNF-? and S100? protein in the peripheral venous blood of the treatment group was significantly lower than that of the control group 1 day after surgery.Moreover,the difference was statistically significant(P<0.05).One day after operation,the levels of IL-10 and TNF-? in peripheral venous blood of two groups were significantly higher than those one day before surgery.On the 1st and3 rd day after operation,results Of S100? protein concentrations in plasma among all patients were going up significantly with statistical difference(P < 0.05),compared with the day before their surgery.The incidence of POCD in the experimental group was significantly lower than that in the control group with significant difference at 1 day after operation(P<0.05).The incidence of POCD in the treatment group was lower than that in the control group at 3days after surgery,but the difference was not statistically significant.CONCLUSION: When dexmedetomidine is used for ERCP examination and surgeries under general anesthesia among old people,the anesthetic effect is safe and reliable.It brings a protective effect on postoperative cognitive function and the lower incidence of postoperative cognitive dysfunction.This mechanism of action may be related to the effects of dexmedetomidine on IL-10,TNF-?,and S100? proteins. |
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