Effect And Mechanism Of Dexmedetomidine Hydrochloride On Cognitive Dysfunction After Cervical Surgery In Elderly Patients

Objective:The purpose is to discuss the effect of dexmedetomidine hydrochloride(DEX)on postoperative cognitive function and the possible mechanism of this effect in elderly patients undergoing cervical spine surgery.Method choices:Total of 90 patients were under selective general anesthesia underwent cervical surgery.All the subjects were randomly divided into three groups:control group(group A,n=30).Combined with routine anesthesia and low-dose intervention.Group(group B,n=30)DEX 0.3 ?g/kg·h,high dose intervention group(group C,n=30)DEX 0.6 ?g/kg·h group.All subjects underwent a combination of inhaled anesthesia and no other anesthetics were used before surgery.Group B and group C were given dexmedetomidine 0.5ug/kg intravenously 10 minutes before anesthesia induction,and the intravenous infusion was completed within 10 minutes.Group A received the same dose of saline infusion.All patients were treated according to the combined static anesthesia.In addition,patients in groups B and C were continuously pumped at a predetermined dose and speed(0.3 ?g/kg·h,0.6?g/kg·h)after endotracheal intubation under visual laryngoscopy until 20 minutes before the end of surgery is expected.The time of surgery and the amount of bleeding were recorded and recorded during major accidents such as major bleeding,respiratory arrest,severe allergic reactions,and the patient was excluded from the study.Intraoperative vital signs and hemodynamics:Record heart rate,mean arterial pressure,pulse oxygen of patients before anesthesia(Ta),cervical vertebrae(Tb),end of anesthesia(Tc),and postoperative 1d(Td).Postoperative cognitive function assessment:All patients had preoperative MMSE,MOCA scale assessment and had excluded basic cognitive impairment,the first day after surgery(D1),the third day(D2),seventh The same assessment was performed again at day(D3)and suspicious POCD patients were recorded.Detection of serum inflammatory markers,including TNF-a,IL-6,CRP,and S-100B,were performed before anesthesia induction(T1),at the end of surgery(T2),24 hours after surgery(T3),and seven days after surgery(At T4),5 ml of blood samples were taken from the patient's venous access,centrifuged at 2000 r/min for 15 min,the supernatant was removed,and stored at low temperature(-70?)and detected sequentially.Results I:Finally,84 patients completed the study,28 cases in each group.There was no significant difference in Sp02 among the three groups.There was no significant difference in HR,MAP between the three groups at the time of Ta and Td(P>0.05).The average HR of group A was 68.4 ±8.5 at the time of Tb,and that of group B was 61.3 ±7.0 and 56.2 ±5.9,the difference was statistically significant(P0.036),and at the same time of Tb,there was significant difference among the three groups of MAP(P0.048).At the time of Tc,there was a significant difference among the three HR groups(P0.029).2:On the first day(D1)and the third day(D2),the MOCA score in group C was significantly higher than that in group A(P 0.037).On the seventh day after operation(D3),there was no significant difference in MOCA score between the three groups(P0.276).The incidence of POCD in group B was significantly lower than that in group A(P0.045).3.There was no significant difference in serum TNF-a,IL-6,CRP,S100-B and NSE between the three groups at T1 time(P>0.05).After operation,serum TNF-a,IL-6,CRP,S100-B and NSE in the three groups all showed a trend of rising first and then decreasing.At T2,T3 and T4 time,serum TNF-a,IL-6,S100-B in group A were significantly higher than those in group B and group C(P<0.05).Serum CRP was significantly higher than that of B,C two group(P=0.000,p=0.0).The serum NSE level of group A was significantly higher than that of group B(P0.014).The level of serum TNF,IL-6 in group B was significantly higher than that in group C(P<0.05)at T 2 and T 3 and T 4(P<0.05).The level of serum NSE in group B at T 2 was significantly higher than that in group C(P 0.014),but the level of serum NSE in group B was lower than that in group B at other times(P<0.05).There was no significant difference(P>0.05).Conclusion 1:The use of DEX in patients with cervical spine surgery can significantly reduce the levels of various inflammatory markers(CRP,TNF-?,IL-6)and nerve injury indicators(S-100B,NSE)in patients after surgery;significant improvement The patient's intraoperative hemodynamic status(reduced heart rate,improved blood pressure fluctuations);and significantly improved postoperative cognitive function scores,reducing the risk of postoperative POCD.It can be considered that the improvement of postoperative POCD symptoms is related to the first three,and the mechanism by which DEX reduces the risk of POCD is related to its inhibition of inflammatory damage,protection of nerve cells,and stabilization of hemodynamics.2:Compared with low-dose continuous pump injection(0.3?g/kg·h)DEX,patients with high-dose continuous pump injection(0.6?g/kg·h)DEX,the effect of inhibiting inflammatory damage,protecting nerve cells and stabilizing the hemodynamics may be more pronounced.