| Background:Postoperative cognitive dysfunction(POCD)refers to the central nervous system complications after anaesthesia surgery,which often show changes in personality,social ability and cognitive ability.Older patients are more likely than other adults to experience memory disorders and other types of cognitive impairment after anesthesia.With the development of medical technology and the coming of aging population,more and more elderly patients need to undergo surgical treatment under anesthesia.The clinical prevention and treatment of POCD is of sufficient practical significance to optimize the prognosis of elderly patients.Neuroinflammatory mechanisms POCD happens for many reasons,at present deserve more attention.Surgical trauma can directly lead to inflammation,resulting in the central nervous system of the cascade induced postoperative cognitive dysfunction.Clinical right beauty holds regular order to reduce the perioperative stress,enhance the analgesic action and reduce the dosage of opioid drugs.According to a study at the university of Beijing for ICU admission of cardiac surgery patients the right beauty(microphones set can prevent postoperative delirium,and from Mount Sinai hospital in New York,Cleveland,Johns Hopkins school of medicine,Mayo clinic medical center hospitals,such as participate in the multicenter study,observed in elderly patients undergoing elective noncardiac surgery using right beauty holds the mi for postoperative delirium and postoperative cognitive dysfunction(POCD),the influence of the results showed that this scheme can reduce the occurrence of postoperative delirium and POCD.So we think about the reasons for the two different research conclusions.Is it related to the timing of drug use and drug combination or the type of surgery selected?Based on this,we designed the study protocol of this experiment,using preoperative dose loading A single dose of dexmedetomidine and parecoxib sodium,intraoperative administration of dexmedetomidine maintenance dose,postoperative parecoxib sodium using a three-day perioperative management model to fully intervene patients,and choose Patients with orthopedic spine surgery with high incidence of POCD underwent neuropsychological tests on the 7th postoperative day to evaluate cognitive function and to observe the effects of parecoxib sodium combined with dexmedetomidine on cognitive function and inflammatory response in elderly patients after spinal surgery and its effect on postoperative analgesia and adverse reactions.Objective:To investigate the effects of perioperative parecoxib sodium combined with dexmedetomidine on postoperative cognitive function and inflammatory response in elderly patients undergoing spinal surgery and their effects on postoperative analgesia and adverse reactions.Methods:116 patients aged over 65 years with ASA Ⅰ-Ⅲ undergoing elective spine surgery were randomly assigned into 2 groups(n=58):Group D with dexmedetomidine,Group PD with parecoxib sodium and dexmedetomidine,the final 99 patients completed the study.PCIA was performed at 72h after intravenous anesthesia.The neuropsychological test scores were evaluated 1 day before surgery and 7 days after surgery.The incidence of POCD was calculated within 7 days after surgery.The serum IL-6,TNF-α,CRP and WBC were measured 1 day before surgery and 1st,3rd and 5th day after surgery.Evaluation preoperative(T0),surgery(T1),postoperative 4h(T2),postoperative 24h(T3),postoperative 48h(T4),postoperative 72h(T5)and postoperative 5 days(T6)VAS resting and exercise/cough score;analysis of correlation between inflammatory factors,white blood cell and VAS scores and POCD occurrence;select of the strongest correlation factor with POCD and the score of each neuropsychological test Z score for linear regression Analysis;observe the amount of 24h analgesic pump solution and 48h analgesic drug remediation rate in both groups;the incidence of postoperative adverse reactions(intraoperative hypoxemia,hypotension,bradycardia,postoperative nausea and vomiting,and agitation)were observed.Results:There were no significant differences in the general data of age,sex,weight,height,ASA grade,hypertension,and diabetes between the two groups(p>0.05).There were no significant differences in surgical data,surgical grouping,operation time,and intraoperative blood loss between the two groups(p>0.05).There was no significant difference in the total amount of fentanyl,total propofol and remifentanil between the two groups(p>0.05).There were no significant differences in anesthesia data between anesthesia time,extubation time(time of withdrawal from anesthesia to extubation),and PACU stay time(p>0.05).Compared with group D,the neuropsychological scale of the PD group had a higher score on MMSE and digital symbol test(p<0.05)and a lower incidence of POCD(p<0.05).Compared with preoperative,CRP was higher at each time point(p<0.05).There was no significant difference between the two groups(p>0.05)on the 5th day after operation(p>0.05).The two groups were higher than the preoperative(p<0.05).The TNF-a was higher in the D group 1 day after operation.There was no significant difference between the two groups(p>0.05).However,compared with group D,IL-6 and CRP were lower in PD group at each time point(p<0.05),and there was no statistical difference between TNF-a groups.Serum IL-6 concentration and serum CRP concentration at 3 days postoperatively were positively correlated with the occurrence of POCD,and the serum CRP concentration was the strongest at 3 days postoperatively.The serum CRP concentration at 3 days after operation was negatively correlated with the cognitive function test Z score at 7 days after operation,including MMSE,digital breadth backstepping test and digital symbol test.Compared with group D,the VAS scores(rest,exercise/cough)were lower in the PD group at T2,T3,T4,and T5,and the dosage of analgesic pump solution at 24 hours and the remedial rate at 48 hours were lower(p<0.05).There were no significant differences in adverse reactions between the two groups,including intraoperative hypoxemia,hypotension,bradycardia,postoperative vomiting,and agitation(p>0.05).Postoperative nausea incidence was lower in the PD group than in the D group.There was a statistically significant difference(p<0.05).Conclusion:In patients with orthopedic spine surgery,cognitive function decreased after surgery,but the incidence of cognitive dysfunction in parecoxib sodium combined with dexmedetomidine group was lower than that in the control group,suggesting that perioperative application of parecoxib Sodium combined with dexmedetomidine can improve postoperative cognitive function and reduce the incidence of postoperative cognitive dysfunction.Compared with the control group,in the peripheral inflammatory response,the IL-6 and CRP values of the parecoxib sodium combined with the dexmedetomidine group were higher than those of the control group 1 day after surgery,3 days after surgery,and 5 days after surgery,and the TNF-a value was lower than that of the control group 1 day after surgery.The CRP serum concentration was positively correlated with the incidence of POCD at 7 days postoperatively,and the Z-score of the cognitive function test with MMSE,digital breadth back test and digital symbol test at 7 days postoperatively.A negative correlation suggests that there may be a link between increased peripheral inflammatory response and decreased postoperative cognitive function.Perioperative application of parecoxib sodium combined with dexmedetomidine can provide better postoperative analgesia and reduce the use of opioids,the incidence of postoperative nausea was lower in terms of adverse reactions. |
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