Effect of Dexmedetomidine on Neurologic and Cognitive Functions and In-flammatory Factor Expression in Elderly Patients Undergoing Knee Ar-throplasty

XIE Xiaoying; GAO Bo; ZHENG Bingqiang; MENG Meng; ZHUANG Qiwei

doi:10.3969/j.issn.1002-3429.2024.15.015

Abstract：Objective To investigate the effects of Dexmedetomidine on neurologic function,cognitive function and expression of inflammatory factors in elderly patients undergoing knee arthroplasty.Methods A total of 120 elderly patients who underwent unilateral total knee arthroplasty(TKA)from March 2022 to March 2023 were selected and divided into groups A,B,C and D by random number table method,with 30 patients in each group.Group A was given combined epidural anes-thesia,while groups B,C and D were given combined epidural anesthesia plus Dexmedetomidine;0.50 μg/kg load dose of Dexmedetomidine was given after flat fixation,and then intravenous micro-pumping was continued at 0.30,0.50 and 0.80 μg/(kg·h),respectively.The levels of serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10)],markers of brain tissue injury[intercellular adhesion molecule-1(ICAM-1),astroglia-derived protein(S-100β)]and Montreal Cognitive Assessment Scale(MoCA)scores before and after operation were com-pared among the four groups.The incidence of postoperative cognitive dysfunction(POCD)and adverse reactions was recor-ded in the four groups.Results The serum levels of TNF-α,IL-6 and IL-10 in the four groups at 1 h,1 d and 3 d after sur-gery were higher than those before surgery(P＜0.05).The levels of S-100β and ICAM-1 in serum of the four groups at 1 h,1 d and 3 d after surgery were higher than those before surgery,which were lower in group D than in groups A,B and C,and lower in group C than in groups A and B(P＜0.05).At 1,3 and 7 d after surgery,MoCA scores in group A and group B were lower than those before surgery(P＜0.05).At 1 and3 d after surgery,MoCA scores in groups C and D were lower than those before surgery(P＜0.05),and recovered to the preoperative level in groups C and D at 7 d after surgery.The MoCA score of group D was higher than that of groups A,B and C at 1 d,3 d and 7 d after surgery,and higher in group C than in groups A and B(P＜0.05).At 3 d after surgery,the incidence of POCD in group D was lower than that in groups A and B,and lower in group C than in group A(P＜0.05).There was no significant difference in the incidence of hypotension and bradycardia among the four groups(P＞0.05).Conclusion In elderly patients undergoing knee arthroplasty,continuous in-jection of Dexmedetomidine at a rate of 0.80 μg/(kg·h)per h during surgery has a more significant effect on reducing post-operative inflammatory injury,neurological injury and cognitive injury,and can ensure anesthesia safety.