|
|
|
| Effects of Dexmedetomidine on postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia |
| YAN Yan |
| Department of Anesthesiology, the First People′s Hospital of Guangzhou City, Guangdong Province, Guangzhou 510180, China |
|
|
|
Abstract Objective To study the effects of Dexmedetomidine on postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia. Methods Sixty elderly scheduled for PFN surgery under spinal anesthesia were enrolled in Nansha Hospital of the First People′s Hospital of Guangzhou City from January to December 2018 were selected as study objects, and they were divided into Dexmedetomidine group (group D, n = 30) and control group (Group C, n = 30) by using random numeral table method. The patients in group D were intravenous infused 0.3 μg/kg Dexmedetomidine within 10 min as premedication 15 minutes before anesthesia, followed by 0.3 μg/(kg·h) infusion until the end of operation． The patients in group C received intravenous infusion of saline. Patient-controlled intravenous analgesia (PCIA) was started for all patients when they were transferred to the ward. The patients were given Sufentanyl 2 μg/(kg·d) as PCIA 100 mL in group C. Group D were given Dexmedetomidine 1 μg/(kg·d) + Sufentanyl 2 μg/(kg·d) as PCIA 100 mL. The levels of MDA and 8-iso PGF2α in serum were detected before anesthesia (T0), 24 h (T1) and 48 h (T2) after operation. The min-mental state examination (MMSE) scores were estimated at T0, T1 and T2. Results The levels of MDA and 8-iso PGF2α at T1 and T2 in two groups were higher than those at T0, but those in group D were lower than those in group C at the same time, the differences were statistically significant (P ＜ 0.05). MMSE scores of T1 and T2 in two groups were lower than those of T0, but those in group D were higher than those in group C at the same time, the differences were statistically significant (P ＜ 0.05). VAS of T1 and T2 in group C was higher than that in group D, and the times of pressing, effective pressing and the dosage of Sufentanil in group C were higher than those in group D, the differences were statistically significant (P ＜ 0.05). Conclusion Dexmedetomidine can reduce the incidence of postoperative cognitive dysfunction in the elderly patients undergoing PFN in perianesthesia.
|
|
|
|
|
|
[1] Carr ZJ，Cios TJ，Potter KF，et al. Does Dexmedetomidine ameliorate postoperative cognitive dysfunction? a brief review of the recent literature [J]. Curr Neurol Neurosci Rep，2018，18（10）：64-74.
[2] Joy T，Rao MS，Madhyastha S. N-acetyl cysteine supplement minimize tau expression and neuronal loss in animal model of Alzheimer′s disease [J]. Brain Sci，2018，8（10）：185-199.
[3] Hemerka JN，Wu X，Dixon CE，et al. Severe brief pressure-controlled hemorrhagic shock after traumatic brain injury exacerbates functional deficits and long-term neuropathological damage in mice [J]. J Neurotrauma，2012，29（12）：2192-2208.
[4] Hui-Jian Shi，Xin-Hong Xue，Yue-Lan Wang，et al. Effects of different anesthesia methods on cognitive dysfunction after hip replacement operation in elder patients [J]. Int J Clin Exp Med，2015，8（3）：3883-3888.
[5] Coburn M，Fahlenkamp A，Zoremba N，et al. Postoperative cognitive dysfunction：incidence and prophylaxis [J]. Anaesthesist，2010，59（2）：177-184.
[6] Rasmussen LS，Johnson T，Kuipers HM，et al. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients [J]. Acta Anaesthesiol Scand，2003， 47（3）：260-266.
[7] Apkarian AV，Mutso AA，Centeno MV，et al. Role of adult hippocampal neurogenesis in persistent pain [J]. Pain，2016，157（2）：418-428.
[8] Weerink MAS，Struys MMRF，Hannivoort LN，et al. Clinical pharmacokinetics and pharmacodynamics of Dexmedetomidine [J]. Clin Pharmacokinet，2017，56（8）：893-913.
[9] Duan X，Coburn M，Rossaint R，et al. Efficacy of perioperative dexmedetomidine on postoperative delirium：systematic review and meta-analysis with trial sequential analysis of randomised controlled trials [J]. Br J Anaesth，2018，121（2）：384-397.
[10] Peng K，Liu HY，Wu SR，et al. Effects of combining Dex-medetomidine and opioids for postoperative intravenous patient-controlled analgesia：a systematic review and Meta-analysis [J]. Clin J Pain，2015，31（12）：1097-1104.
[11] Folstein MF，Folstein SE，McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician [J]. J Psychiatry Res，1975，12（3）：189-198.
[12] Rohan D，Buggy DJ，Crowley S，et al. Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly [J]. Can J Anaesth，2005，52（2）：137-142.
[13] An LN，Yue Y，Guo WZ，et al. Surgical trauma induces iron accumulation and oxidative stress in a rodent model of postoperative cognitive dysfunction [J]. Biol Trace Elem Res，2013，151（2）：277-283.
[14] Owczarek D，Cibor D，Mach T. Asymmetric dimethylarginine （ADMA），symmetric dimethylarginine （SDMA），arginine，and 8-iso-prostaglandin F2alpha （8-iso-PGF2alpha） level in patients with inflammatory bowel diseases [J]. Inflamm Bowel Dis，2010，16（1）：52-57.
[15] Clausen F，Marklund N，Lewén A，et al. Interstitial F（2）-isoprostane 8-iso-PGF（2α） as a biomarker of oxidative stress after severe human traumatic brain injury [J]. J Neurotrauma，2012，29（5）：766-775.
[16] Zheng YB，Ruan GM，Fu JX，et al. Postoperative plasma 8-iso-prostaglandin F2α levels are associated with delirium and cognitive dysfunction in elderly patients after hip fracture surgery [J]. Clin Chim Acta，2016，455（1）：149-153.
[17] Akpinar H，Akpinar O. The effects of dexmedetomidine on biomarkers of oxidative stress and antioxidants in kidney [J]. Bratisl Lek Listy，2018，119（8）：476-480.
[18] Yu J，Yang W，Wang W，et al. Involvement of miR-665 in protection effect of dexmedetomidine against Oxidative Stress Injury in myocardial cells via CB2 and CK1 [J]. Biomed Pharmacother，2019，115：108894.
[19] Li F，Wang X，Deng Z，et al. Dexmedetomidine reduces oxidative stress and provides neuroprotection in a model of traumatic brain injury via the PGC-1α signaling pathway [J]. Neuropeptides，2018，72：58-64.
[20] Rodríguez-González R，Sobrino T，Veiga S，et al. Neuroprotective effects of dexmedetomidine conditioning strategies：evidences from an in vitro model of cerebral ischemia [J]. Life Sci，2016，144（1）：162-169.
[21] Vuyk J，Sitsen E，Reekers M，et al. Intravenous anesthetics [M]. Miller′s Anesthesia，2015：854-859. |
|
|
|
