Effects Of Low-dose Dexmedetomidine Combined With Epidural Anesthesia On Cognitive Dysfunction In Elderly Patients With Orthopedics

Objective:Observing the effects of perioperative low-dose dexmedetomidine combined with epidural anesthesia on POCD in elderly patients with orthopedics and discussing the mechanism of its occurrence,providing new ideas for clinical prevention and treatments.method:200 elderly patients who were scheduled for orthopedic elective surgery under continuous epidural anesthesia were selected,and the patients were divided into dexmedetomidine group(group A)and blank saline group(group B)by random number table method,100 cases in each group.In group A,dexmedetomidine0.5?g/kg continuous micropump pump injection(10 min)was used before operation.After successful epidural puncture,dexmedetomidine was given 0.2?g/kg/h rate by micropump during the operation.Pump injection until 30 minutes before the end of the operation;continuous micropump injection(10 min)with saline 0.5 ?g/kg before operation in group B.After successful epidural puncture,0.2 ?g/kg saline was given intraoperatively with micropump/h.Simultaneously record the systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,and BIS values at the relevant time points of the two groups of patients at the time of admission(T0),1h(T1),and postoperative(T2);and measure T0,T1,T2 The concentration of norepinephrine and epinephrine in venous blood at time point;using the Mini-Mental State Examination Scale(MMSE)to record and compare the two groups of patients at T0,6 h after surgery(T3),1 d after surgery(T4),surgery The score at the second 2days(T5)and the incidence of postoperative cognitive dysfunction(POCD)were counted.result:There were no significant differences in age,gender,smoking,alcohol consumption,BMI,ASA grade,history of cerebrovascular disease,hypertension,hyperglycemia,hyperlipidemia,operation time,blood loss,fluid replacement,andpreoperative MMSE scores between the two groups of patients(P>0.05).There was no significant difference in systolic,diastolic,mean arterial pressure,heart rate,and BIS values between the two groups of patients at T0 and T2(P>0.05);systolic,diastolic,average arterial pressure,and heart rate of T1 in the two groups The values of BIS and BIS were lower than those of T0,but group A was relatively lower than group B,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the NE and E levels of T0 and T2 between the two groups of patients(P>0.05);the NE and E levels of T1 and T2 in the two groups were lower than those of T0,but the A group was compared with the B group.Relatively lower,the difference is statistically significant(P<0.05).There was no statistically significant difference in the MMSE scores of the two groups at T0(P>0.05),and the MMSE scores in group B were lower than those in group A at T3,T4,and T5(P<0.05);the difference in group A was 7 days after operation The incidence of POCD was 5%(5/100),and the incidence of POCD within 7 days after operation in group B was 15%(15/100).The data comparison was statistically significant,P<0.05.conclusion:Dexmedetomidine is used in the anesthesia of orthopedic elderly patients.Its method is simple,accurate,safe and reliable,and can effectively prevent the occurrence of postoperative cognitive dysfunction(POCD).