| Objective to explore the effects of dexmetomidine,lung protective ventilation strategy and combination on postoperative POCD in elderly patients with laparoscopic colorectal cancer by measuring IL-6,IL-10,S100 β protein and MMSE score,so as to provide new ideas and methods for reducing the incidence of POCD and improving the postoperative prognosis of elderly patients with colorectal cancer.Methods 120 elderly patients undergoing elective laparoscopic colorectal cancer surgery under general anesthesia in our hospital from December 2018 to December2019 were selected.The patients were randomly divided into four groups:conventional ventilation group(group C),lung protective ventilation strategy group(group P),dexmetomidine + conventional ventilation group(group CD),lung protective ventilation strategy + dexmetomidine group(PD group).CD group and PD group were given 0.5 μ g / kg dexmetomidine load before anesthesia induction for 10 minutes.After endotracheal intubation,0.5 μ g /(kg ·h)was continuously pumped until 30 min was stopped before the end of operation.C and P groups were given the same volume of normal saline in the same way.Group C and CD were ventilated with conventional ventilation after intubation(VT:10ml/kg,I:E=1:2);group P and group PD were ventilated with lung protective ventilation strategy(VT:6ml/kg,I:E=1:2,PEEP:5cm H2 O,received regular lung reexpansion with 30 min every interval).Peripheral venous blood samples were taken at 1 day before operation(T0),6 hours after operation(T1)and 1 day after operation(T2)for interleukin-6(IL-6),interleukin-10(IL-10)and astrocyte Smur100β protein(S100β protein).The cognitive function was tested with(MMSE)at 1 day before operation(T0),1 day after operation(T2),3 days after operation(T3)and 7 days after operation(T4).The incidence of POCD was evaluated according to the compound Z method recommended by the international POCD research group.Results(1)There was no significant difference in sex,education,age,BMI,ASA grade,volume of operation and duration of anesthesia among the four groups(P >0.05);(2)There was no significant difference in the level of IL-6 among the four groups at T0 time point(P > 0.05).The IL-6 of PD group,P group and CD group was lower than that of C group at T1 and T2 time points,and that of PD group was significantly lower than that of the other three groups(P < 0.05).(3)There was no significant difference in IL-10 among the four groups at T0 time point(P > 0.05),but IL-10 in PD and CD groups was significantly higher than that in C and P groups at T1 time point,and that of group PD was significantly higher than that of CD at T1 time point,while that in PD and CD groups at T2 time point was significantly higher than that in C group,and that in PD group was significantly higher than that in the other three groups(P < 0.05);(4)There was no significant difference in Smur100 β protein level among the four groups at T0 time point(P > 0.05).At T1 time point,the S100 βprotein of PD group,P group and CD group was lower than that of C group,PD group was significantly lower than that of C and CD groups(P < 0.05),and that of PD group,P group and CD group at T2 time point was lower than that of C group,PD group was significantly lower than that of the other three groups(P < 0 05).(5)There was no significant difference in the MMSE score among the four groups at T0 time point(P >0.05),Compared with T0,the MMSE score of T2,T3,T4 in C group was significantly lower than that of T0(P < 0 05).In the inter group comparison of T2,T3,T4 time point,the MMSE score of group P and CD was significantly higher than that of group C,while the score of MMSE of group PD was significantly higher than that of group P and CD(P < 0.05);There was no significant difference between P group and CD group(P > 0.05).(6)The incidence of POCD in the four groups: there was no significant difference in the incidence of T2,T3,T4 in group C(P > 0.05).Compared with group C,the incidence of POCD at T2,T3,T4 in P group,CD group and PD group decreased significantly(P < 0 05),and the incidence of POCD in PD group decreased further at T2 and T3 time point compared with P group and CD group(P < 0 05).Conclusion1.Dexmedetomidine combined with lung protective ventilation strategy can significantly reduce the incidence of POCD in elderly patients undergoing laparoscopic colorectal cancer surgery.2.Dexmedetomidine combined with lung protective ventilation strategy is used in elderly patients undergoing laparoscopic colorectal surgery.Compared with single application,the combination of dexmedetomidine and pulmonary protective ventilation can further reduce the levels of IL-6 and S100-β protein,increase the level of IL-10,and produce a synergistic anti-inflammatory effect. |
