| Objective In the case of dexmedetomidine combined with lumbar epidural anesthesia and sedation,to investigate the relationship about the changes of cerebral blood flow and postoperative cognitive function in elderly patients preparing for transurethral resection of the prostate,and to provide reference for clinical work.Methods Select 80 elderly patients,aged 65 to 89,body mass index 18.5 to 23kg/m~2,ASA grade II or III,with prostatic hypertrophy who underwent transurethral resection of the prostate under combined lumbar and epidural anesthesia from January1,2021 to October 31,2021 in Affiliated Hospital of Yanbian University.The random number table was used in the experiment,and the patients were randomly assigned to2 groups with 40 cases in a group.the combined lumbar and epidural anesthesia(SE group),Combined spinal-epidural anesthesia combined with dexmedetomidine sedation group(DE group).Record pre-anesthesia(T0),dexmedetomidine pump injection after 10min(T1),30 minutes at the beginning of surgery(T2),and recovery position at the end of surgery(T3).Mean arterial pressure(MAP),heart rate(HR),mean peak flow rate of middle cerebral artery(Vmean)and pulse index(PI)were recorded at different times.MMSE scores were measured at 6h,1d,and 7d postoperatively.Results1.Effects of dexmedetomidine on MAPIn DE group,MAP gradually decreased less than T0 at T1,T2 and T3(P<0.05),T1>T2(P>0.05),T2>T3(P>0.05)and T1>T3(P>0.05).In SE group,MAP gradually decreased less than T0 at T1,T2 and T3(P<0.05),T1>T2(P<0.05),and T2>T3(P<0.05).There was no obvious discrepancy within the two groups at T0(P>0.05).DE group was lower than SE group at T1,T2 and T3(P<0.05).2.Effect of dexmedetomidine on HRIn DE group,HR declined gradually at T1 and T2,but increased at T3 but less than T0(P<0.05),T1>T2(P>0.05),T1<T3(P>0.05)and T2<T3(P>0.05).In SE group,HR decreased gradually at T1 and T2,increased at T3 but less than T0(P<0.05),T1>T2(P<0.05),T1<T3(P<0.05).There was no significant difference between the two groups at T0(P>0.05).DE group was lower than SE group at T1,T2 and T3(P<0.05).3.Effect of dexmedetomidine on VmeanIn DE group,Vmean gradually decreased less than T0 at T1,T2 and T3(P<0.05),T1>T2(P>0.05),T2>T3(P>0.05)and T1>T3(P>0.05).In SE group,Vmean gradually decreased less than T0 at T1,T2 and T3(P<0.05),T1>T2(P<0.05),and T2>T3(P<0.05).There was no obvious discrepancy within the two groups at T0(P>0.05),and DE group was lower than SE group at T1,T2 and T3(P<0.05).4.Effect of dexmedetomidine on PIThe PI gradually decreased at T1,T2,and T3 in both groups than at T0(P<0.05),at T1>T3(P<0.05),and at T2>T3(P<0.05).There was no significant difference between the two groups at T0,T2,and T3(P>0.05),but there was a significant difference at T1(P<0.05).The DE group was lower than the SE group at T1,T2,and T3.5.Effect of dexmedetomidine on POCDThere was no significant difference in MMSE scores between the two groups at6h,1d,and 7d after operation(P>0.05).Both groups had different degrees of POCD after operation,but there was no significant difference in the incidence of POCD at each time point between the DE group and the SE group.(P>0.05),with the prolongation of time,the incidence of POCD in both groups decreased.In the DE group,there was no significant difference between 6h after operation,1d and 7d after operation(P>0.05).),there was no significant difference between postoperative 1d and postoperative 7d(P>0.05).In SE group,there was no significant difference between postoperative 6h and postoperative 1d and postoperative 7d(P>0.05).There was no significant difference between postoperative 1d and postoperative 7d(P>0.05).Conclusion1.Changes in cerebral blood flow under Dexmedetomidine sedation does not increase the incidence of POCD undergoing transurethral resection of the prostate under combined spinal-epidural anesthesia in elderly patients.2.Dexmedetomidine sedation can reduce blood pressure,stabilize hemodynamics,and provide a favorable environment for surgery. |
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