Effects Of Dexmedetomidine Combined With Propofol On Circulation And Postoperative Delirium In Elderly Patients Undergoing Lumbar Spine Surgery

Objective:To explore the anesthetic effect of dexmedetomidine combined with propofol and intravenous general anesthesia using propofol alone in elderly patients undergoing lumbar spine surgery,and to investigate the effect on perioperative circulation and postoperative delirium of patients,so as to provide reference for the selection of anesthesia methods for elderly patients undergoing lumbar spine surgery in the future.Methods:A prospective cohort study was conducted to randomly select 90 elderly patients who underwent lumbar surgery in our hospital from September 2018 to March 2020,including 46 males and 44 females,with an age distribution of 60-85 years.The study was approved by the hospital ethics committee,and the informed consent was signed by the patients or their family members.According to the principle of odd and even random grouping,the above cases were randomly divided into observation group and control group,with 45 cases in each group.General information of the two groups of research subjects includes:In the observation group,23 cases were male and 22 cases were female,with the age distribution ranging from 60 to 85 years old,and the average age was 65.9±18.8 years old.There were 19 cases of lumbar disc herniation,15 cases of lumbar fracture,8 cases of lumbar tumor,and the other 3 cases.In the control group,23 cases were male and 22 cases were female,with an age distribution of 61-83 years old,with an average age of 65.7±20.1 years old.There were 18 cases of lumbar disc herniation,16 cases of lumbar fracture,9 cases of lumbar tumor,and 2 other cases.After analysis,there was no significant difference in general information and severity of disease between the two groups(P>0.05).The observation group was given general anesthesia with dexmedetomidine combined with propofol,while the control group was given general anesthesia with propofol alone.Both groups were given intravenous anesthesia with endotracheal intubation.After entering the operating room,ecg,blood pressure,oxygen saturation and BIS monitoring were connected.Induction of anesthesia:The observation group was injected with 1 ?g/kg dexmedetomidine diluted with normal saline to 50 ml(concentration 4 ?g/ml),and the infusion time was 10 min.The control group was injected with normal saline of the same volume.Both groups were given fentanyl 1.0?g/kg,propofol 0.5 mg/kg-1.0 mg/kg,atracurium cisphenylsulfonic acid 0.1 mg/kg dose to induce anesthesia.Maintenance of anesthesia:With BIS monitoring values in the range of 40-60,the target control velocity of propofol was regulated to be between 2.0 mg/kg.h-4.0 mg/kg.h,the target control speed of Remifentanil was controlled between 0.1 ?g/kg.min-0.2?g/kg.min,and cisatracurium was injected intermittently.The pumping velocity of dexmedetomidine was regulated to be 0.3?g/kg.h in the observation group,and the control group was given the same amount of normal saline.During the perioperative period,the hemodynamics of the study subjects were monitored.When the patients' respiratory status and BIS monitoring values changed,the pumping volume of propofol and remifentanil was increased or decreased appropriately,and the time for stopping the infusion of anesthetic agents was set as 5 minutes before the end of the operation.Patients were set to enter the operating room(basic value T0),pump dexmedetomidine or normal saline for 10min(T1),immediately after intubation(T2),and 5 minutes after intubation(T3).T4 represents the beginning of the operation,T5 represents the exposure of the superior spinous ligament,and T6 represents the exploration and determination of the lesion site.T7 represents the moment before extubation,T8 represents the moment 5 minutes after extubation,T9 represents the moment 10 minutes after extubation,and T10 represents the moment 15 minutes after extubation.The main observation index was the incidence of postoperative delirium.In this paper,SPSS20.0 statistical software,descriptive statistical analysis and t-test were used to analyze the clinical efficacy,circulatory index,delirium and other recorded data of 90 patients in perioperative period.Setting P<0.05 has statistical significance.Results:1.Induction periodIntra-group comparison:The SBP,DPH,MAP and HR data of the observation group at time points T2 and T3 were lower than those at time points T0,and the whole process showed a downward trend after induction,with statistically significant differences(P<0.05).Comparison between groups:At the instant of intubation(T2),the data showed that the hemodynamic indexes of SBP,DPH,MAP and HR in the observation group were lower than those in the control group at the same time,and the difference between the two groups at the same time(T2)was statistically significant(P<0.05).2.Operation process:Intra-group comparison:The hemodynamic indexes of the subjects in the control group at the time of T5 and T6 were significantly higher than the corresponding indexes of T4 at the beginning of surgery,and the difference was statistically significant(P<0.05).Comparison between groups:At the time nodes of T5 and T6,hemodynamic indexes such as SBP,DPH,MAP and HR in the observation group were significantly lower than those in the control group,showing statistical significance(P<0.05).3.Extubation period:Intra-group comparison:The MAP,HR and other hemodynamic indexes of the control group at each moment of T8,T9 and T10 were significantly higher than the corresponding indexes at the moment of T7,with statistically significant differences(P<0.05).Comparison between groups:The MAP,HR and other indexes of circulatory hemodynamic indicators of the subjects in the observation group at each moment of T8,T9 and T10 were lower than those of the control group at the same time,with statistically significant differences(P<0.05)4.There was no significant difference in the wake time,breathing recovery time and extubation time between the observation group and the control group(P>0.05)5.At the time of T8 and T9,Ramsay sedation score in the observation group was significantly higher than that in the control group,with statistically significant difference(P<0.05).At time T10,there was no significant difference in Ramsay sedation score between the observation group and the control group(P>0.05).6.At the time of T8 and T9,Richmond agitation score(RASS)in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).At time T10,there was no significant difference in the score of Richmond agitation between the observation group and the control group(P>0.05).7.The total MMSE levels of the observation group at 8h,24h and 48h after operation were significantly higher than those of the control group,with statistically significant differences(P<0.05)8.The incidence of delirium in the control group was significantly higher than that in the observation group,the difference was statistically significant(x2=9.263,P=0.021).9.There was no statistically significant difference in the incidence of adverse reactions between the control group and the observation group(P>0.05).Conclusions:For under the condition of general anesthesia in elderly patients with lumbar spine surgery,using the right microphones on composite propofol is a separate line using propofol intravenous general anesthesia is more stable patients perioperative hemodynamic changes,improve the effect of perioperative patients with sedation,reducing the occurrence of the awakening period restlessness,reduce the incidence of delirium in patients.