Abstract:Objective To study the effect of Dexamethasone on postoperative delirium and cognitive dysfunction in elderly patients with joint replacement surgery. Methods Two hundred and twenty-five elderly patients with joint replacement surgery [≥65 years old, American Society of Anesthesiologists (ASA) Ⅱ-Ⅲ grade] in the First Affiliated Hospital of Chengdu Medical College from September 2015 to December 2016 were selected. These patients were divided into low dose of Dexamethasone group (group D1), high dose of Dexamethasone group (group D2) and control group (group C) by random number table, with 75 cases in each group. One hour before operation, group D1 was given intravenous injection of Dexamethasone 10 mg, group D2 was given intravenous injection of Dexamethasone 20 mg, group C was given intravenous injection of equal quantity of normal saline. The confusion assessment method-Chinese revision (CAM-CR), mini-mental state examination (MMSE) and visual analogue scale (VAS) were used to evaluate postoperative delirium, postoperative cognitive dysfunction and postoperative pain of the patients respectively. Results After operation for 1, 3, 7 days, the scores of CAM-CR in group D1 and D2 were all lower than those of group C, and the scores of MMSE were all higher than those of group C, with statistically significant differences (all P < 0.01), while there were no significant differences of VAS scores compared with those of group C (P > 0.05). There were no significant differences of the scores of CAM-CR, MMSE and VAS after operation for 1, 3, 7 days between group D1 and D2 (all P > 0.05). After operation for 1, 3, 7 days, the incidence of postoperative delirium and cognitive dysfunction were all lower than those of group C, with statistically significant differences (all P < 0.05), while there were no significant differences of the incidence of postoperative delirium and cognitive dysfunction after operation for 1, 3, 7 days between group D1 and D2 (P > 0.05). Conclusion Application of Dexamethasone before operation can reduce the incidence of postoperative delirium and postoperative cognitive dysfunction in elderly patients underwent joint replacement surgery.
[1] Androsova G,Krause R,Winterer G,et al. Biomarkers of postoperative delirium and cognitive dysfunction [J]. Front Aging Neurosci,2015,7:112.
[2] Rudolph JL,Marcantonio ER,Culley DJ,et al. Delirium is associated with early postoperative cognitive dysfunction [J]. Anaesthesia,2008,63(9):941-947.
[3] Mason SE,Noel-Storr A,Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium:a systematic review with meta-analysis [J]. J Alzheimers Dis,2010,22 Suppl 3:67-79.
[4] Steinmetz J,Christensen KB,Lund T,et al. Long-term consequences of postoperative cognitive dysfunction[J]. Anesthesiology,2009,110(3):548-555.
[5] Chen Q,Chen J,Hu B,et al. Submucosal injection of dexamethasone reduces postoperative discomfort after third-molar extraction:a systematic review and meta-analysis [J]. J Am Dent Assoc,2017,148(2):81-91.
[6] 李娟,邹义壮,冯锋,等.谵妄评定方法修订及其信度、效度测试[J].临床精神医学杂志,2003,13(3):147-149.
[7] Jiang J,Chen Z,Liang B,et al. Insulin-like growth factor-1 and insulin-like growth factor binding protein 3 and risk of postoperative cognitive dysfunction [J]. Springer Plus,2015, 4:787.
[8] Yang L,Sun DF,Wu Y,et al. Intranasal administration of butorphanol benefits old patients undergoing H-uvulopalatopharyngoplasty:a randomized trial [J]. BMC Anesthesiol,2015,15:20.
[9] Berger M,Nadler JW,Browndyke J,et al. Postoperative cognitive dysfunction:minding the gaps in our knowledge of a common postoperative complication in the elderly [J]. Anesthesiol Clin,2015,33(3):517-550.
[10] Grifasi C,Calogero A,Esposito A,et al. Perioperative care of elderly outpatients:A review [J]. Ann Ital Chir,2015, 86(2):100-105.
[11] Hogan KJ. Hereditary vulnerabilities to post-operative cognitive dysfunction and dementia [J]. Prog Neuropsychopharmacol Biol Psychiatry,2013,47:128-134.
[12] Chu CS,Liang CK,Chou MY,et al. Lack of association between pre-operative insulin-like growth factor-1 and the risk of post-operative Delirium in elderly Chinese patients [J]. Psychiatry Invest,2016,13(3):327-332.
[13] Guerrero-Berroa E,Luo X,Sehmeidler J,et al. The MMSE orientation for time domain is a strong predictor of subsequent cognitive decline in the elderly [J]. Int J Geriatr Psychiatry,2009,24(12):1429-1437.
[14] Lv ZT,Huang JM,Zhang JM,et al. Effect of Ulinastatin in the Treatment of Postperative Cognitive Dysfunction:Review of Current Literature [J]. Biomed Res Int,2016, 2016:2571080.
[15] 陈勇,杜晓红,金夏,等.星状神经节阻滞对老龄大鼠血清S100β蛋白、NSE及术后认知功能的影响[J].临床麻醉学杂志,2013,29(10):1020-1023.
[16] 朱华荣,熊新军.养心健脑方对老年患者术后认知功能障碍及相关生物标记物的影响[J].世界中医药,2017, 12(2):352-354,358.
[17] 李世元.骨科手术患者俯卧位全身麻醉术后认知功能观察[J].中国医学创新,2015,12(7):10-13.
[18] Leiendecker J,H?觟cker J,Meybohm P,et al. Postoperative neurocognitive function and microembolus detection in patients undergoing neck dissection:a pilot study [J]. Eur J Anaesthesiol,2010,27(5):417-424.
[19] Valentin LS,Pereira VF,Pietrobon RS,et al. Effects of single low dose of Dexamethasone before noncardiac and nonneurologic surgery and general anesthesia on postoperative cognitive dysfunction-a phaseⅢ double blind,randomized clinical trial [J]. PLoS One,2016,11(5):e0152308.
[20] Barichello T,Santos AL,Silvestre C,et al. Dexamethasone treatment reverses cognitive impairment but increases brain oxidative stress in rats submitted to pneumococcal meningitis [J]. Oxid Med Cell Longev,2011,2011:173035.
[21] Wan Y,Xu J,Ma D,et al. Postoperative impairment of cognitive function in rats:a possible role for cytokine-mediated inflammation in the hippocampus [J]. Anesthesiology,2007,106(3):436-443.
[22] Riedel B,Browne K,Silbert B. Cerebral protection:inflammation,endothelial dysfunction,and postoperative cognitive dysfunction [J]. Curr Opin Anaesthesiol,2014,27(1):89-97.