Effects Of Dexmedetomidine On Early Cognitive Function And Expression Of Tumor Necrosis Factor-α(TNF-α)in Laparoscopic Hysterectomy Patients

Objective:To investigate the effects of dexmedetomidine on laparoscopic hysterectomy patients’early cognitive function and tumor necrosis factor-α（TNF-α）.Methods:Sixty cases of laparoscopic hysterectomy under elective general anesthesia were selected,aged 45～60 years old,with ASA grade I-II,and without other important organ dysfunction.They were random Ly divided into control group（group C,n=30）and dexmedetomidine group（group D,n=30）.The patients of group D received intravenous dexmedetomidine（1μg/kg）over 15 minutes before induction of anesthesia,followed by a continuous dexmedetomidine infusion(0.5μg/kg/h until 30min before the end of the operation,the control group（group C）was given normal saline with the same dosage as group D.Anesthesia induction:sufentanil injection 0.5μg/kg,etomidate injection0.3mg/kg and rocuronium injection 0.7mg/kg were slowly injected intravenously.Anesthesia maintenance:intravenous infusion of propofol 4-10mg/kg/h and remifentanil 0.05-0.20μg/kg/min,and the maintained infusion rate was adjusted at any time according to changes in HR and BP,intermittent intravenous bolus rocuronium bromide injection 0.2mg/kg to maintain muscle loosening,add sufentanil as needed.The EEG dual frequency index（BIS）was maintained at 40-60 to maintain proper anesthesia depth.Anesthetic drugs are discontinued after surgery in all patients.The patient was sent to the anesthesia recovery room to observe the anesthesia recovery after extubation.The patient was treated with self-controlled intravenous analgesia.The drug was sufentanil 2μg/kg+ondansetron 8mg+physiological saline and diluted to 200m L.Blood samples were collected from the patients at different time points.In the two groups,5m L of the patient’s peripheral venous blood was collected before anesthesia induction（T₀）,at the beginning of operation（T₁）,the end of operation（T₂）,and the time of 12h after operation（T₃）,placed in a procoagulant tube,and centrifuged at 3000r/min for 10minutes to separate the serum.Then,TNF-αlevels were measured by ELISA.Visual analogue scale（VAS）was used to evaluate the pain of the two groups at 24 hours and 48 hours after operation The mini-mental state examination（MMSE）.was used to test the cognitive function of the two groups of patients at 1day before operation（D₀）,postoperative 1day（D₁）,postoperative 3day（D₂）,postoperative 7day(D₃).Results:（1）There was no significant difference in the MMSE score between the two groups at 1 day before surgery（D₀）（P>0.05）.Compared with D₀,the MMSE score was lower at D₁-D₃ after surgery,and the difference was statistically significant（P<0.05）;Compared with group C,the MMSE score of group D was significantly improved at D₁,D₂,and D₃ after surgery,and the difference was statistically significant（P<0.05）.（2）There was no significant difference in TNF-αlevels between the two groups of patients before induction of anesthesia（T₀）（P>0.05）.Compared with T₀,the serum TNF-αlevels at T₁-T₃postoperatively increased significantly,and the difference was statistically significant（P<0.05）.Compared with group C,the serum TNF-αlevels of patients in group D were significantly reduced on T₁,T₂,and T₃ after surgery,and the differences were all significant,and the difference was statistically significant（P<0.05）.（3）General information and ASA classification of patients in the two groups,Operation time,fluid volume,urine volume,blood loss,hemodynamic changes and other differences were not statistically significant（P>0.05）.（4）There was no significant difference in postoperative VAS scores between the two groups（P>0.05）.Conclusions:Dexmedetomidine could down-regulate the expression of serum TNF-αin perioperative period,reduce the inflammatory reaction caused by anesthesia and surgical stimulation,and protect patients’neurocognitive function in perioperative period,thus reducing the incidence of early postoperative cognitive dysfunction in patients undergoing laparoscopic hysterectomy,improving the prognosis of patients,and facilitating rapid recovery after surgery.It has important clinical guiding value and is worthy of wide popularization.