Effect Of SAPB Assisted General Anesthesia On Postoperative Cognitive Function In Elderly Patients Undergoing Thoracoscopic Lobectomy

Objective:To observe the effect of dexmedetomidine combined with ropivacaine for ultrasound-guided serratus anterior plane block on postoperative pain and cognitive function in elderly patients undergoing thoracoscopic lobectomy.Methods:Ninety patients undergoing thoracoscopic lobectomy in the First Affiliated Hospital of Hebei North University were selected,aged≥65 years,BMI 20～30 kg·m^-2,and ASA physical status ofⅡ～Ⅲ.The patients were divided into three groups by random number table method（n=30）:control group（group C）,ropivacaine group（group S）,ropivacaine combined with dexmedetomidine group（group SD）.Group C was treated with general anesthesia;Group S was treated with general anesthesia combined with SAPB,and the local anesthetic was 0.4%ropivacaine;Group SD was treated with general anesthesia combined with SAPB,and the local anesthetic was 0.4%ropivacaine combined with 0.5ug·kg^-1dexmedetomidine.Record:1.Mini-mental state Examination（MMSE）scores before operation,24 hours and 72 hours after operation.2.The consumption of propofol and remifentanil during operation,the total effective pressing times of analgesic pump（D₁）,the actual pressing times of analgesic pump（D₂）,and D₁/D₂were calculated.3.VAS scores at rest and cough at 12 hours,24 hours and 36 hours after operation.4.The concentrations of tumor necrosis factor-α（TNF-α）,interleukin-10（IL-10）and S100βprotein before operation,24 hours and 72 hours after operation.The incidence of intraoperative hypotension,bradycardia,and postoperative nausea and vomiting was recorded.Results:1.There were no significant differences in age,gender,ASA grade,BMI,operation time,and intraoperative blood loss among the three groups（P>0.05）.2.There was no significant difference in MMSE scores among the three groups before operation（P>0.05）.Compared with group C,MMSE scores at 24 h and 72 h after operation were significantly increased in group S and group SD（P<0.05）.Compared with group S,the MMSE score at 72 h after operation was significantly increased in group SD（P<0.05）.3.Compared with group C,the consumption of propofol and remifentanil was significantly decreased,the total number of effective compressions and the actual number of compressions were decreased,and the ratio of the two was increased in S and SD groups（P<0.05）.Compared with group S,the total effective pressing times of analgesic pump were significantly decreased in group SD（P<0.05）.4.Compared with group C,VAS scores at rest and cough at 12 h and 24 h after operation were significantly decreased in S and SD groups（P<0.05）.Compared with group C and group S,VAS scores at rest and cough at 36 h after operation were significantly decreased in group SD（P<0.05）.5.There were no significant differences in preoperative TNF-α,IL-10 and S100βprotein concentrations among the three groups（P>0.05）.Compared with group C,the concentrations of TNF-αand IL-10 were significantly decreased at 24 h after operation in S and SD groups（P<0.05）.Compared with group S,the concentration of TNF-αwas significantly decreased at 24 h after operation in group SD（P<0.05）.Compared with group C,S100βprotein concentration was significantly decreased at 24 h and 72 h after operation in S and SD groups（P<0.05）.6.There was no significant difference in the incidence of intraoperative hypotension and bradycardia among the three groups（P>0.05）.Compared with group C,the incidence of postoperative nausea and vomiting in group S and SD was lower（P<0.05）.Conclusions:General anesthesia combined with SAPB can provide good intraoperative and postoperative analgesia for elderly patients undergoing thoracoscopic lobectomy,reduce the dosage of general anesthetics and opioids,reduce the inflammatory response of the body,and reduce the occurrence of postoperative cognitive dysfunction.In particular,ropivacaine combined with dexmedetomidine can prolong the analgesic time and enhance the analgesic intensity of SAPB,and further reduce the incidence of postoperative cognitive dysfunction.