Effects Of Different Anesthesia Methods And Dexmedetomidine Application On Early Cognitive Dysfunction After Electrosurgical Prostatectomy In Elderly Patients

Part one:Effects of different anesthetic methods on early cognitive dysfunction after electrosurgical prostatectomy in elderly patientsObjective:To observe the effect of combined lumbar and epidural anesthesia(CSEA)and general anesthesia(GA)on early cognitive dysfunction in.elderly patients undergoing radical prostatectomy.Materials.and Methods:Selection 80 cases of elderly patients in our hospital for the Transurethral resection of prostate(TURP)and divided into general anesthesia(GA)group and combined spinal and epidural anesthesia(CSEA)group,each group of 40 people?Specific observation indexes including two way movement in patients with motor block onset time(MBOT),sensory block onset time(SBOT),duration of motor block(DMB)and duration of sensory block(DSB);Postoperative adverse reactions and complications;The MMSE scale was used to calculate the incidence rate of postoperative cognitive impairment at different time points by calculating the mental state of patients at 6h,24h and within one week before and after surgery and evaluating the improvement degree of cognitive function.Postoperative satisfaction of patients in both groups was investigated.Results:The difference in general condition and preoperative MMSE score between the two groups was not statistically significant(P>0.05).Compared with general anesthesia(GA)group,the MBOT and SBOT in CSEA group were faster(P<0.05);DMB are longer(P<0.05)and DSB are shorter(P<0.05);Postoperative complications were less(P<0.05);MMSE scores were higher at 6h,24h and 7d after surgery(P<0.05);The incidence of postoperative cognitive impairment was lower(P<0.05);Postoperative satisfaction was higher(P<0.05).Conclusions:Compared with general anesthesia,combined spinal and epidural anesthesia has less effect on the incidence of early cognitive dysfunction after prostate electrosurgical operation in elderly patients,which is worthy of further clinical To promote.Part two:Effects of different dosages of dexmedetomidine on early cognitive impairment in elderly patients after prostatectomyObjective:To investigate the effect of dexmedetomidine on early cognitive function in senile patients after prostatectomy.Materials and methods:A total of 90 elderly patients in our hospital to undergo electrosurgical prostatectomy were selected and divided into the control group,the dexmedetomidine 1(Dex1)group and the dexmedetomidine2(Dex2)group,with 30 patients in each group.Intravenous infusion of dexmedetomidine within 10min before induction of general anesthesia in the Dex1-2 group,with a loading of 0.5 ?g/kg and 1 ?g/kg respectively,followed by constant drip of dexmedetomidine until half an hour before surgery.The same method was used in the control group for intravenous injection of 0.9%sodium chloride solution.Specific examination and examination indicators were as follows:the specific operative time,blood loss,urine volume and infusion volume of the three groups of patients were recorded.1 day before operation,postoperative 1 day,7 days and 1 week after collecting three groups of patients right internal jugular vein blood samples,using ELISA method for determination of serum high mobility group protein 1(HMGB1),tumor necrosis factor(TNF-?,IL-6,IL-1 and so on the change of concentration at all time points;MMSE scale data statistics;Postoperative adverse reactions and patient satisfaction were statistically analyzed.Results:There was no statistically significant difference(P>0.05)between the three groups in operation duration and preoperative observation indexes(HMGB1,TNF-?,IL-1 ?,IL-6,MMSE score).Compared with the control group,the blood loss and infusion volume of Dexl group and Dex2 group were less(P<0.05);In the comparison of MMSE score,inflammatory factor level,incidence rate of cognitive impairment,and satisfaction at each time point 6h,24h and 7d after surgery,the difference between the Dexl group and the Dex2 group was statistically significant(P<0.05);The difference was also statistically significant between the Dex2 group and the Dexl group(P<0.05).It can be seen that with the extension of postoperative time and the increase of appropriate dose of dexmedetomidine,the overall level of the three groups of patients had increased MMSE score,decreased inflammatory factors,decreased incidence of cognitive impairment,and increased satisfaction.Conclusions:Dexmetomidine can effectively reduce the occurrence of POCD after electrosurgical prostatectomy.Dexmetomidine can significantly inhibit the concentration of interleukin-IL-6 and TNF-a after surgery,and effectively control the incidence of postoperative cognitive impairment in patients.