Objective: To observe the effects of Hydromorphone(HM) combined with Dexmedetomidine(Dex) on stress response and Perioperative neurocognitive disorders(PND) in elderly patients undergoing laparoscopic surgery. Methods: A total of 90 elderly patients (age 65 or older) who underwent elective laparoscopic surgery in our hospital from September 2020 to August 2021 were randomly divided into 3 groups ,the hydromorphone group (H), the combined group (DH) and the control group ,with 30 patients in each group, ASA grade Ⅱ~Ⅲ. 30min before the end of surgery, group H was intravenously injected with HM 10μg/kg, group DH was intravenously injected with HM 10 μg/kg and pumped with Dex 0.5 μg/kg plus normal saline 20 mL within 10min, and the control group was injected with the same amount of normal saline. Anesthesia and postoperative follow-up were performed in all three groups by the same anesthesiologist. Mean arterial pressure(MAP) and Heart rate(HR) were recorded before induction of anesthesia (T0), after establishment of pneumoperitoneum (T1), after operation (T2), 3 min after extubation (T3) and 6 h after extubation (T4). The Montreal Cognitive Assessment Scale (MoCA) was used for MoCA scores 1 d before surgery, 24 h after extubation (T5) and 48h after extubation (T6). Plasma Norepinephrine (NE), Cortisol (Cor) and Interleukin-6(IL-6)concentrations at T0, T3, T4 and T5 were measured. S100β protein concentration at T0, T4, T5 and T6; The recovery time of spontaneous breathing, eye-opening time and extubation time were recorded. The incidence of adverse reactions in three groups was recorded. Results: 1.At T2, T3 and T4, HR and MAP of group H and group DH were lower than those of the control group, and group DH was lower than those of group H (P<0.05); 2.The concentrations of NE, Cor and IL-6 in each group were increased at T3 and T4 compared with T0 (P<0.05), the concentrations of NE, Cor and IL-6 in H group and DH group were lower than those in Control group at T3 and T4 (P<0.05), and the concentrations of DH group were lower than those in H group (P<0.05); 3.Compared with T0, the concentrations of S100β protein in T4 and T5 groups were increased (P<0.05), and those in H and DH groups were lower than those in Control group (P<0.05), and those in DH group were lower than those in H group (P<0.05); 4.MoCA score in all groups decreased after operation (P<0.05), but DH group was higher than H group and Control group (P<0.05); 5.The incidence of bradycardia in DH group was higher than that in H group and Control group (P>0.05), but there was no significant difference in the incidence of other adverse reactions (P>0.05). Conclusion: Hydromorphone combined with Dexmedetomidine can effectively reduce stress response and Perioperative neurocognitive disorders in elderly patients undergoing Laparoscopic surgery.
WU Yehui
,
CHEN Biao
. To compare the effects of Hydromorphone alone and in combination with Hydromorphone on perioperative stress and cognition in the elderly[J]. Journal of Baotou Medical College, 2023
, 39(3)
: 49
-54
.
DOI: 10.16833/j.cnki.jbmc.2023.03.011
[1] 孙艺, 林蓉, 熊莉华, 等. 广州市学生视力不良与户外活动时间关系[J].中国学校卫生,2019,40(7):997-1000.
[2] 郭坚明. 广州市海珠区中小学生近视防治知信行调查[J].中国健康教育,2008,24(2):127-128.
[3] 刘秀英. 中国青少年近视率排世界第一[J].少年儿童研究,2017(7):61-62.
[4] 国家卫生健康委员会疾控局,北京大学儿童青少年卫生研究所. 2021年全国学生常见病和健康影响因素监测与干预技术工作手册[M].北京,2021.
[5] 王燕, 刘玮, 苏俊海, 等. 兰州与合肥市中小学生2014年视力不良及影响因素分析[J].中国学校卫生,2017,38(1):72-75,79.
[6] 王菊芳. 曲靖市第一中学2010-2013年学生视力不良情况分析[J].中国公共卫生管理,2015,31(3):439-440.
[7] 汤晓佳, 董彬, 杨招庚, 等. 中国藏族学生视力现状及其影响因素分析[J].中国学校卫生,2019,40(2):256-258.
[8] 谌丁艳, 李晓恒, 周丽, 等. 深圳市中小学生近视影响因素分析[J].中国学校卫生,2020,41(4):583-587.
[9] 刘盛鑫, 叶盛, 曹永军, 等. 天津市中小学生读写习惯对视力不良的影响[J].中国学校卫生,2018,39(1):9-12.
[10] 夏志伟, 王路, 赵海, 等. 北京市2017-2018学年中小学生视力不良及影响因素分析[J].中国学校卫生,2018,39(12):1841-1844.
[11] 谢新艳, 杨莉华, 杨长春, 等. 武汉市中小学生2019-2020年视力不良现况[J].中国学校卫生,2021,42(8):1237-1241.