Effect Of Lidocaine And Different Doses Of Dexmedetomidine On Prevention Of Delirium In Middle Aged And Elderly Breast Surgery

Objective:To compare the efficacy and safety of lidocaine and different doses of dexmedetomidine in the prevention of delirium in middle aged and elderly breast surgery.Methods:Choose the fellowship at jilin university hospital aged 50-75 of 120 patients with women in the study of the regular breast surgery,patients with ASA and cardiac function were limited to grade I,II,and the patient group time between September 2020-January 2021 between,through the random number table method for its implementation group,divided into use lidocaine group(group A): at the beginning of anesthesia induction,using TCI dual channel trace the first channel vein pump injection amount of saline until 30 min before the end of the operation;The second channel of micropump was injected with 2% lidocaine by intravenous pump at a rate of 0.5mg/Kg/h until the end of surgery(group B): TCI double-channel micropump was used to inject 0.4μg/ Kg dexmedetomidine injection 15 minutes after anesthesia induction.After the completion of loading pumping,dexmedetomidine was continued to be pumped at a rate of 0.2ug/kg/h until 30 min before the end of surgery.Meanwhile,the second channel of micropump was injected with the same amount of normal saline until the end of surgery with lidocaine combined with low-dose dexmedetomidine load group(group C): 0.4μg/kg dexmedetomidine injection was injected with the TCI double-channel micropump and the first channel intravenous pump 15 minutes after anesthesia induction;After the completion of loading pumping,dexmedetomidine was continued to be pumped at a rate of 0.2μg/kg/h until 30 min before the end of surgery.Meanwhile,the second channel of the micropump was intravenously pumped with 2% lidocaine at a rate of 0.5mg/Kg/h until the end of surgery.Group D: TCI double-channel micropump was used to inject 0.8μg/ Kg dexmedetomidine injection 15 minutes after anesthesia induction.After the completion of loading pumping,dexmedetomidine was continued to be pumped at a rate of 0.2μg/kg/h until 30 min before the end of surgery.At the same time,the second channel of the micropump was injected with 2% lidocaine at a rate of 0.5mg/Kg/h intravenously until the end of the operation.The following indexes were recorded and compared in each group: the pulse,oxygen saturation,heart rate and mean arterial pressure were recorded at the time of entry(T0),immediately after endotracheal intubation(T1),and immediately after extubation(T2);Analgesia degree(NRS score and VAS score)sedation degree(modified OAA/S score)delirium assessment(CAM score)and the total number of compressions in 48 hours of postoperative analgesia pump PCIA were measured 30min(T3)and 24h(T4)after surgery and 48h(T5)after surgery.The incidence of respiratory depression after delirium and nausea and vomiting was recorded within 48 hours after operation.The incidence of intraoperative hypotension bradycardia was recorded.Intraoperative ephedrine,attropine,propofol,sufentanil,and remifentanil dosage were recorded.Extubation time of each group was recorded.Results:There were no statistically significant differences in general information(including age,ASA grade,BMI),operative duration,intraoperative blood loss,and extubation time among the four groups(P>0.05).The consumption of propofol and remifentanil in the combination group of dexmedetomidine and lidocaine(CD group)was lower than that in the single group(AB group),group A>B group > C group >Group D.The dexmedetomidine combined with lidocaine group(CD group)had better analgesic,sedative and delirium prevention effects than lidocaine alone group(A group)and dexmedetomidine alone group(B group).The postoperative analgesic score,delirium score and the number of postoperative analgesic pump pressure in CD group were significantly lower than those in AB group(P<0.05).The sedation score of the combined application group CD was significantly higher than that of group A and B(P<0.05);In addition,the combination of lidocaine and dexmedetomidine in the low-dose dexmedetomidine load group(group C)and the high-dose dexmedetomidine load group(group D)had the same effect of preventing delirium with fewer side effects,and had statistical significance(P<0.05).The incidence of postoperative nausea and vomiting(PONV)was also decreased in the BCD group compared with the lidocaine group A,and the combined application of the two groups had A better effect than that of the lidocaine group alone,but there was no significant difference in the effect when the dosage of the combined application was increased.The lidocaine combined with high dose dexmedetomidine load group(D group)had a higher incidence of intraoperative circulatory system inhibition such as bradycardia and hypotension than the ABC group,and the intraoperative application times and doses of ephedrine and atropine were increased,the differences were statistically significant(P<0.05).Conclusion:The combined use of lidocaine and dexmedetomidine in the elderly breast surgery can effectively reduce the incidence of postoperative delirium,and the effect is better than that of lidocaine and dexmedetomidine alone.Lidocaine combined with low dose of dexmedetomidine load group(0.4μg/kg)had better perioperative effect of preventing delirium and fewer side effects than the combined with high dose of dexmedetomidine load group(0.8μg /kg).