[Effect of dexmedetomidine on inflammatory factors level and cognitive function after femoral head replacement in elderly patients].

Objective: To analyze the effect of dexmedetomidine on the inflammatory factors level and cognitive function after femoral head replacement in elderly patients.

Methods: From January 2016 to December 2017, 60 elderly patients(more than 60 years old, and Grade I to II of ASA) treated with femoral head replacement were divided into three groups, and 20 in each group. All patients received midazolam, fentanyl, etomidate, cisatracurium anesthesia induction and sevoflurane inhalation anesthesia maintenance. The patients in group B and group C were first given 1.0 μg·kg⁻¹ of dexmedetomidine 10 minutes during the operation. The maintenance volume was 0.3 μg·kg⁻¹·h⁻¹ of dexmedetomidine(in group B) and 0.6 μg·kg⁻¹·h⁻¹ of dexmedetomidine(in group C) by pumping. The same amount of saline was given to the patients in group A in the same way. The time of extubation, wakefulness and recovery, the simple intelligent mental state score (MMSE), the incidence of postoperative cognitive dysfunction (POCD) and the levels of interleukin-6 (IL-6), interleukin-10 (IL-10) and S100β protein expression in the 3 groups were compared.

Results: There were significant differences in the time of spontaneous breathing recovery, eye opening tome and the time of extubation, as well as the dosage of propofol among the three groups(<0.05). On the 1st, 3rd and 7th day after operation, there was a significant difference in MMSE score of group B and group C compared with that of group A(<0.05), and MMSE score in group C was significantly higher than that of group B(<0.05). The incidence of POCD was 0.0% (0/20) and the incidence of adverse reactions was 30%(6/20) in group C, but those were 25% (5/20) and 0.0% (0/20) in group A and 5% (1/20) and 10% (2/20) respectively in group B. The difference was statistically significant (<0.05). Before induction of anesthesia, there was no significant difference in the levels of IL-6, IL-10 and S100β protein among the three groups(>0.05); but one hour after the operation, the levels of IL-6 IL-10 and S100β protein in group B and group C was statistically different from those in group A(<0.05). The IL-6 and S100β protein in group C were significantly lower than those in group B (<0.05), and IL-10 was significantly higher than that in group B (<0.05).

Conclusions: For elderly patients operated for femoral head replacement, dexmedetomidine can reduce the level of inflammatory factors level and propofol consumption, and the incidence of postoperative POCD is low, indicating a dose dependence of dexmedetomidine. But it is necessary to choose the right dose according to the patient's condition.