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Abstract：
OBJECTIVE: Postoperative cognitive dysfunction (POCD) is a serious surgical complication. We assessed the different POCD incidences between anesthesia using sevoflurane and sevoflurane combined with dexmedetomidine, with propofol-based sedation in elderly patients who underwent a thoracic surgical procedure.
METHODS: A total of 90 patients aged 65 to 80 years old who underwent a thoracic surgical procedure at our hospital and 15 nonsurgical participants as controls, were enrolled in this study. Patients were divided in a randomized 1:1:1 ratio into 3 groups. All participants were randomized into a trial with three anesthesia groups (P, PS, PSD) or a control group (C) of healthy matches. All trial groups received distinct anesthetic combinations during surgery, while controls mirrored patient criteria.Group P (propofol and remifentanil were maintained during the surgery), Group PS (propofol, remifentanil, and sevoflurane were maintained during the surgery), and Group PSD (propofol, remifentanil, sevoflurane, and dexmedetomidine were maintained during the surgery).All participants were rated using a series of cognitive assessment scales before and three days after surgery. All participants were interviewed over the telephone, 7 days, 30 days, and 90 days postoperatively.
RESULTS: POCD incidences in the PSD (combined anesthetization with propofol, sevoflurane, and dexmedetomidine) group was significantly lower than that in the PS (combined anesthetization with propofol and sevoflurane) group, 1 day post-surgery (10.0% vs. 40.0%, P = 0.008), and the results were consistent at 3 days post-surgery. When the patients were assessed 7 days, 30 days, and 90 days postoperatively, there was no significant difference in POCD incidence among the three groups. Multivariate logistic regression analysis of POCD one day after surgery showed that education level was negatively correlated with incidence of POCD (P = 0.018) and single lung ventilation time was positively correlated with incidence of POCD (P = 0.001).
CONCLUSIONS: For elderly patients who underwent a thoracic surgical procedure, dexmedetomidine sedation shows an obvious advantage on improving short-term POCD incidence, which is caused by sevoflurane.
METHODS: A total of 90 patients aged 65 to 80 years old who underwent a thoracic surgical procedure at our hospital and 15 nonsurgical participants as controls, were enrolled in this study. Patients were divided in a randomized 1:1:1 ratio into 3 groups. All participants were randomized into a trial with three anesthesia groups (P, PS, PSD) or a control group (C) of healthy matches. All trial groups received distinct anesthetic combinations during surgery, while controls mirrored patient criteria.Group P (propofol and remifentanil were maintained during the surgery), Group PS (propofol, remifentanil, and sevoflurane were maintained during the surgery), and Group PSD (propofol, remifentanil, sevoflurane, and dexmedetomidine were maintained during the surgery).All participants were rated using a series of cognitive assessment scales before and three days after surgery. All participants were interviewed over the telephone, 7 days, 30 days, and 90 days postoperatively.
RESULTS: POCD incidences in the PSD (combined anesthetization with propofol, sevoflurane, and dexmedetomidine) group was significantly lower than that in the PS (combined anesthetization with propofol and sevoflurane) group, 1 day post-surgery (10.0% vs. 40.0%, P = 0.008), and the results were consistent at 3 days post-surgery. When the patients were assessed 7 days, 30 days, and 90 days postoperatively, there was no significant difference in POCD incidence among the three groups. Multivariate logistic regression analysis of POCD one day after surgery showed that education level was negatively correlated with incidence of POCD (P = 0.018) and single lung ventilation time was positively correlated with incidence of POCD (P = 0.001).
CONCLUSIONS: For elderly patients who underwent a thoracic surgical procedure, dexmedetomidine sedation shows an obvious advantage on improving short-term POCD incidence, which is caused by sevoflurane.
摘要：
目的：术后认知功能障碍（POCD）是一种严重的手术并发症。我们评估了七氟醚麻醉和七氟醚联合右美托咪定麻醉的不同POCD发生率。在接受胸外科手术的老年患者中使用基于丙泊酚的镇静。
方法：共有90名年龄在65至80岁在我院接受胸外科手术的患者和15名非手术参与者作为对照，参加了这项研究。患者以1:1:1的比例随机分为3组。所有参与者被随机分为三个麻醉组（P，PS,PSD）或健康匹配的对照组（C）。所有试验组在手术期间接受不同的麻醉组合，而对照组反映了患者的标准。P组(术中维持异丙酚和瑞芬太尼),PS组(异丙酚，瑞芬太尼,和七氟醚在手术过程中保持），和PSD组(异丙酚，瑞芬太尼,七氟醚,术中维持右美托咪定）。所有参与者在手术前和手术后三天使用一系列认知评估量表进行评估。所有参与者都通过电话接受了采访，7天,30天,术后90天。
结果：PSD的POCD发生率（异丙酚联合麻醉，七氟醚,右美托咪定)组明显低于PS(丙泊酚七氟醚联合麻醉)组,术后1天（10.0％vs.40.0%,P=0.008),术后3天结果一致。当患者被评估7天，30天,术后90天，三组的POCD发生率无显著差异.术后1天POCD的多因素logistic回归分析显示,文化程度与POCD发生率呈负相关(P=0.018),单肺通气时间与POCD发生率呈正相关(P=0.001)。
结论：对于接受胸外科手术的老年患者，右美托咪定镇静对改善短期POCD发生率有明显优势,是由七氟烷引起的.
方法：共有90名年龄在65至80岁在我院接受胸外科手术的患者和15名非手术参与者作为对照，参加了这项研究。患者以1:1:1的比例随机分为3组。所有参与者被随机分为三个麻醉组（P，PS,PSD）或健康匹配的对照组（C）。所有试验组在手术期间接受不同的麻醉组合，而对照组反映了患者的标准。P组(术中维持异丙酚和瑞芬太尼),PS组(异丙酚，瑞芬太尼,和七氟醚在手术过程中保持），和PSD组(异丙酚，瑞芬太尼,七氟醚,术中维持右美托咪定）。所有参与者在手术前和手术后三天使用一系列认知评估量表进行评估。所有参与者都通过电话接受了采访，7天,30天,术后90天。
结果：PSD的POCD发生率（异丙酚联合麻醉，七氟醚,右美托咪定)组明显低于PS(丙泊酚七氟醚联合麻醉)组,术后1天（10.0％vs.40.0%,P=0.008),术后3天结果一致。当患者被评估7天，30天,术后90天，三组的POCD发生率无显著差异.术后1天POCD的多因素logistic回归分析显示,文化程度与POCD发生率呈负相关(P=0.018),单肺通气时间与POCD发生率呈正相关(P=0.001)。
结论：对于接受胸外科手术的老年患者，右美托咪定镇静对改善短期POCD发生率有明显优势,是由七氟烷引起的.
