Effects of dexmedetomidine on the autonomic balance and incidence rate of POCD in patients receiving gynecological laparoscopic surgery

LI Shiduo; AI Lun

doi:10.3969/j.issn.1002-7386.2017.18.008

Abstract：Objective To investigate the effects of dexmedetomidine on the autonomic balance and incidence rate of postoperative cognitive dysfunction (POCD)in patients receiving gynecological laparoscopic surgery. Methods One hundred and fifty - two patients with ovarian cyst who underwent laparoscopic surgery in our hospital from January 2015 to June 2016 were randomly divided into control group (n = 76)and observation group (n = 76). Before operation the patients in control group were given 0. 9% sodium chloride solution by intravenous injection,however,the patients in observation group were given dexmedetomidine by intravenous injection,then the patients in both groups received laparoscopic ovarian cyst resection. The changes of heart rate (HR),diastolic blood pressure (DBP),systolic blood pressure (SBP)and brain electric double frequency index (BIS)before and after operation were observed and compared between two groups. Moreover the consciousness recovery time,sedation score,comfort degree score,VAS score,heart rate variability,incidence rates of POCD and adverse reactions were observed and analyzed. Results During skin incision and extubation after surgery,there were significant differences in HR,SBP,DBP,BIS between two groups (P < 0. 05). The Ramsay sedation scores in observation group were significantly higher than those in control group (P < 0. 05),and the consciousness recovery time in observation group was significantly longer than that in control group (P < 0. 05),however,there were no significant differences in comfort degree scores and VAS scores between two groups (P > 0. 05). The incidence rates of POCD in observation group were significantly lower than those in control group (P < 0. 05),moreover DRS scores in observation group were significantly lower than those in control group (P < 0. 05). The LF at T2 in observation group was significantly lower than that at T0 (P < 0. 05),and LF/ HF at T1 in control group was significantly higher than that at T0 (P < 0. 05),but there were no significant differences in the other indexes between two groups (P > 0. 05). The incidence rates of agitation,nausea,postoperative pain and the other adverse reactions in observation group were significantly lower than those in control group (P < 0. 05 ). Conclusion The dexmedetomidine can effectively inhibit the stress response caused by pneumoperitoneum during gynecological laparoscopic surgery,which can improve the sympathetic and vagal balance,relieve the cognitive function consciousness impairment and decrease the incidence rate of POCD,with a certain nerve protection effects.