Effects Of Dexmedetomidine Combined With Peripheral Nerve Block On Serum IL-1?,IL-6,TNF-? And Early Postoperative Cognitive Function In Elderly Patients Undergoing Hip Surgery

Objective:To investigate the effects of dexmedetomidine combined with peripheral nerve block on serum inflammatory factor levels and postoperative cognitive function changes in elderly patients undergoing hip surgery,and to provide new scientific evidence for further optimization of anesthesia.Methods:80 elderly patients with artificial unilateral total hip arthroplasty were selected from the Second hospital of Shanxi Medical University from January 2018 to June 2019,aged65 to 80 years,and gender was not limited.ASA grade I to III were excluded.Patients with coronary heart disease,cerebral infarction,alcohol abuse,strong dependence on drugs,hemorrhagic and other diseases should sign an informed consent form with the patient or family before surgery.They were randomly divided into group A?control group?,group B?observation group 1?,group C?observation group 2?,and group D?observation group 3?,with 20 cases in each group.In group A,subarachnoid block anesthesia were only received before operation;in group B,dexmedetomidine was continuously pumped 0.1 to 0.4?g/?kg·h?during operation;in group C,10 minutes before the operation,ultrasound guidance was performed with fascia block;in group D,ultrasound-guided patellar fascia block was performed 10 minutes before surgery,and dexmedetomidine was continuously pumped 0.1 to 0.4?g/?kg·h?during the operation.All patients enrolled were performed by the same surgeon.Venous blood samples were collected before anesthesia?T₀?,after surgery?T₁?and 24 hours after surgery?T₂?.The concentrations of serum IL-1?,IL-6 and TNF-?were measured.SpO2,HR and MAP levels were recorded before anesthesia?T₀?,at the beginning of surgery?T₃?and 30minutes after surgery?T₄?.The incidence of postoperative nausea and vomiting,abdominal pain and diarrhea,and the rate of admission to ICU were observed.Results:80 cases in accordance with the criteria of inclusion and exclusion,20 cases in each group.No significant difference in sex,age,height,weight and BMI between groups?P>0.05?.1.The SpO2 between four groups were not statistically significant at T₀,T₃ and T₄?P>0.05?.2.The HR and MAP of group A increased at T₃ and T₄ compared with T₀,while group B and D decreased significantly at T₃ and T₄ compared to T₀.The decrease of HR and MAP in group B was higher than that in group D?P<0.05?,no significant difference in group C at each time point?P>0.05?.3.Compared with T₀,the levels of IL-1?,IL-6 and TNF-?were significantly higher between groups at T₁ and T₂?P<0.05?,no significant difference between T₁ and T₂?P>0.05?.4.At T₀,no significant difference in the levels of IL-1?,IL-6 and TNF-?between groups?P<0.05?.5.At T₁ and T₂,the levels of IL-1?,IL-6 and TNF-?in group B,C and D were lower than group A,those in group D were lower than group B and C?P<0.05?.No significant difference between group B and group C?P>0.05?.6.The incidence of nausea and vomiting was highest in group A and lowest in group D?P<0.05?.No significant statistical difference in the incidence of abdominal pain,diarrhea and admission to ICU among groups?P>0.05?.7.No significant difference in MMSE scores between four groups 1day before surgery?P>0.05?.The MMSE scores in group B,C,and D were significantly higher than those in group A.Group D was higher than group B and C at the third and seventh day after operation.MMSE scores of four groups all declined in different degrees on the third day after operation,with the smallest decrease in D group.On the seventh day after operation,the scores of group D basically recovered to the preoperative,while other three groups had no significant changes.Conclusion:Continuous pumping of dexmedetomidine or peripheral nerve block alone during surgery can reduce serum inflammatory factors levels in elderly patients with hip joint surgery,improve postoperative cognitive function,and reduce the incidence of postoperative nausea and vomiting.However,the combined application of the two methods has a more significant effect,which is conductive to the outcome of elderly patients.