Effect of Entropy Index-Targeted Dextromeetomidine on Postoperative Neurocognitive Function in Elderly Patients with Gastrointestinal Tumors

Abstract

Yin Xuejun, Xie Wei Nong, Zhang Haoyu and Hu Jing

Objective: To investigate the effect of entropy index targeted monitoring combined with dexmedetomidine infusion on cognitive function after thoracic and abdominal surgery in elderly patients.
Methods: 60 elderly patients undergoing abdominal surgery in our hospital on October ~2017 and October 2019 were selected, ASAâ?¡~ grade III, and the random digital table method was divided into 3 groups ,20 cases in each group. entropy index monitoring combined with dexmedetomidine group (D1 group), entropy index monitoring combined with dexmedetomidine group (D2 group) and dexmedetomidine monitoring combined with saline group (D0 group). All patients were subjected to sequential rapid induction of endotracheal intubation general anesthesia. D1, D2, the group was injected with 0.5μg/kg dexmedetomidine hydrochloride intravenously in the first 15 min of induction, followed by a 0.3μg•kg-1•h-1, 0.6μg•kg-1•h-1 maintenance pump until 30 minutes before the end of operation, respectively. The D0 group was injected with the same amount of saline intravenously before induction, and then maintained with the same amount of saline. D1 and D2 groups were calibrated at 40~60. preoperative (T1), tracheal intubation immediate (T2),30 min after operation (T3) and extubation immediate (T4) M after operation were compared in 3 groups AP (mmhg), hr (sub/ min), blood oxygen saturation (SpO2) and intraoperative anesthetic dosage, vasoactive drug use, and postoperative recovery status; simple intelligent mental state examination scale (MMSE) test was completed 1 day before ,1 day after ,3 days after and 7 days after operation to record the incidence of perioperative neurocognitive disorders (PND). To detect the necrosis factor-α(TNF-α) and C-reactive protein (CRP) of the above-mentioned concurrent serum tumors; Results Compared with D0 group, the MAP of D1 group and D2 group decreased significantly and the HR slowed down significantly (P<0.05), The MAP, HR of T3, T4 in D2 group was significantly decreased compared with that in the D1 group (P<0.05), but the difference was not significant at all time points (0.05);The respiratory recovery time (min), dialling time (min) and restoring directional force time (min) were significantly shortened compared with the D0 group and the D2 group, and the consumption of propofol and sufentanil during the operation was significantly decreased. Compared with the D2 group, the use of vasoactive drugs in the D1 group was significantly decreased (P<0.05). The TNF-α, CRP of patients in the first day and the third day were higher than those in the first day of operation, but the TNF-α, CRP of D1 group and D2 group were lower than those in the D0 group (0.05). The MMSE scores of l days and 3 days after operation in D1 and D2 groups were higher than those in D0 groups. Significantly decreased (P<0.05), and there was no significant difference between the groups 7 days after operation (P>0.05): Conclusion entropy index targeted monitoring combined with dexmedetomidine infusion (0.3μg/kg/h) in the elderly patients during surgery can improve the intraoperative and postoperative hemodynamic stability, can improve the perioperative neurocognitive disorders of patients, worthy of clinical promotion.

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