| BackgroundPostoperative cognitive dysfunction（POCD）is defined as a series of clinical complications of the central nervous system in elderly patients during the perioperative period,including the impairment of orientation ability,memory function and abstract thinking,accompanied by the change and decline of cognitive ability and social activity.Even mental disorders and personality changes.And improvements in global health care systems have led to a gradual increase in the elderly population.Most elderly patients present with temporary postoperative delirium or prolonged POCD after surgery.It is estimated that many older people in the world have undergone surgery more than once,and as they age,these changes in turn affect their ability to withstand injury,surgery and anesthesia stress.However,with the acceleration of aging and the rapid increase of population,more and more elderly patients and patients with high comorbidity and morbidity choose surgery.Therefore,it is urgent to pay more attention and further study on the prevention and treatment of POCD and the exact etiology.ObjectiveTo investigate the effects of dexmedetomidine on regional cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer.Methods64 elderly patients who planned to undergo laparoscopic radical gastrectomy for gastric cancer were selected as the research objects,and 64 patients were divided into two groups by random number table method,including dexmedetomidine group（group D）and control group（group C）with 32 patients in each group.Dexmedetomidine was pumped 0.4 μg/（kg·h）,and the pumping rate was adjusted to 0.2μg/（kg·h）10 min later,and the pumping was maintained until 30 min before the end of surgery.Group C was pumped with an equal volume of normal saline.After the patient entered the operating room,radial artery puncture and catheterization were performed under local anesthesia for pressure measurement,right internal jugular vein puncture and catheterization for infusion,and anesthesia induction:intravenous infusion of sufentanil 0.3μg/kg,propofol 0.5-1.5 mg/kg,atracurium cis-benzenesulfonate 0.15 mg/kg.After induction,the combination of static aspiration was maintained,continuous inhalation of 1%～3%sevoflurane,continuous pumping of remifentanil 10 μg/（kg·h）,continuous pumping of propofol 3 mg/（kg·h）,continuous pumping of atracurium cisbenzenesulfonate intraoperatively to maintain four series of stimulation（TOF）（T4/T1 at 0）.Intraoperatively,sufentanil was added intermittently,and blood pressure was regulated by methoxamine,nitroglycerin,and dopamine to maintain stable circulation.Bispectral index（BIS）was maintained between 40 and 60.Covidien cerebral oxygen and regional monitoring system were used to detect Regional cerebral oxygen saturation（rSO2）,arterial partial pressure of oxygen（PaO2）,Arterial partial pressure of carbon dioxide（PaCO2）,heart rate（HR）,mean arterial pressure（MAP）and rSO2 were recorded when patients entered the operating room（T1）,after intubation under general anesthesia（T2）,pneumoperitoneum opened for 60 min（T3）,and after awakening（T4）.The scores were recorded by MMSE on 1 day before operation,1 day,3 days and 7 days after operation,and the occurrence of POCD was recorded.ResultsThere was no statistical difference in the observation indexes at each time point.Intra-group comparison:Compared with T1,the PaCO2 and rSO2 of the two groups were significantly higher at T3 and T4（P<0.05）.The cases of POCD in the two groups were as follows:2 cases（6.67%）in group D and 8 cases（26.67%）in group C（P<0.05）.ConclusionThe use of DEX in laparoscopic radical gastrectomy for elderly patients with gastric cancer does not lead to a further increase in rSO2,but can reduce the occurrence of early POCD.DEX plays a certain role in preventing POCD in elderly patients after surgery. |
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