Influence Of Different Levels Of Urapidil Controlled Blood Pressure Reduction On Postoperative Cognitive Function Of Patients Undergoing Shoulder Surgery

Objective To investigate the effect of different levels of controlled blood pressure on the cognitive function of patients with shoulder arthroscopic surgery by measuring the concentration of S100β protein,NSE and MMSE score in plasma,and to further study the most appropriate blood pressure level to provide future clinical work Theoretical basis.Determine whether there is a correlation between the occurrence of POCD and cytokine levels.Methods A total of 60 patients who underwent shoulder arthroscopic surgery under elective general anesthesia in our hospital from December 2019 to December 2020 were selected.The 60 patients were divided into two groups(n=30).The blood pressure was reduced to 80% of the preoperative MAP(CH1 group),and the blood pressure was reduced to 70% of the preoperative MAP(CH2 group).After the induction of anesthesia,both groups were given intravenously 0.3-0.6mg/kg urapidil to induce blood pressure reduction,followed by 8-12ug/(kg·min)as the maintenance amount,and dropped to the corresponding blood pressure level of the set group After the operation is performed,the blood pressure reduction is terminated after the key steps of the operation are completed,and the blood pressure reduction lasts no more than 1.5 hours.Mean arterial pressure(MAP)was recorded at the time points before controlled hypotension(T1),controlled hypotension 30min(T2),and controlled hypotension 60min(T3)after induction of anesthesia;Record the basic conditions during the operation: the amount of infusion,the amount of bleeding,the amount of urine,the amount of medication,the length of the operation,etc;1d before operation(T0),postoperative 1d(T4),2d(T5),and 4d(T6)after surgery,the S100β protein and NSE concentration in peripheral venous blood plasma were measured by ELISA method,and the cognitive function of patients was scored using the MMSE score sheet.The Z-score method recommended by the POCD research group is used to calculate the score and evaluate the incidence of POCD.Results(1)The general data of the two groups were not statistically significant;(2)The dosage of urapidil in the CH2 group was more statistically significant than that in the CH1 group;(3)There was no statistically significant comparison of S100β protein and NSE levels in the two groups at T0 Scientific significance;Compared with T0,the S100β protein and NSE levels of the two groups at T4 and T5 increased significantly,which was statistically significant;(4)Compared with the CH1 group,the S100β protein and NSE levels of the CH2 group at T4 and T5 increased more significantly,Statistically significant;(5)There was no difference in the MMSE scores of the two groups at T0 time;compared with T0,the MMSE scores of the two groups at T4 and T5 decreased,which was statistically significant;(6)Compared with the CH1 group,CH2 at T4 and T5 The MMSE score of the group decreased more significantly and was statistically significant;(7)Compared with the CH1 group,the CH2 group had an increase in the incidence of POCD at the T4 and T5 time points,which was statistically significant;there was no statistically significant comparison of the incidence of POCD between the two groups at T6.Conclusion1.Maintaining a low level of mean arterial pressure(MAP)during the operation will increase the incidence of early postoperative cognitive dysfunction;2.In patients with cognitive dysfunction,serum S100β protein and NSE levels are higher than those without impairment,and there is a certain correlation between the two and the occurrence of POCD.