| Objective To investigate the effects of total intravenous anesthesiaand general anesthesia combined with epidural anesthesia on postoperative cognitive function in elderly patients with elective colon cancer radical surgery.To compare Regulatory T cells(Regulatory T cells,Tregs)expression in these two anesthesia methods: to explore the effect of Tregs on postoperative cognitive function in elderly patients or to provide new ideas for the prevention and treatment of postoperative cognitive dysfunction.Methods(1)100 elderly patients with elective radical tumor resection from September 2017 to October 2018 were selected,aged 65-80 years,and American Society of Anesthesiologists(ASA)graded I to II.Excluding the History of the nervous system or history of craniocerebral injury;history of severe alcohol abuse or psychotropic medication;history of severe psychosis;diabetes;abnormal coagulation;liver and kidney dysfunction.(2)Randomly divided into group G(total intravenous anesthesia)and group C(general anesthesia combined with epidural anesthesia).(3)Cognitive function was assessed by simple intelligence score(MMSE)at 1 day before surgery and 6h,、1d,、3d and 5d after surgery.Continuing telephone follow-up in January and March after surgery,and patient Cognitive functionwas assessed by MMSE(4)Venous blood was collected1 day before induction and 1st day after surgery.Flow cytometry analysis showed that CD4+CD25+CD127-Tregs accounted for the proportion of peripheral CD4+ T lymphocytes,Group C and group G were compared intra-group.on the 1day before surgery and on the 1st day after surgery,CD4+CD25+CD127-Tregs accounted for the proportion of peripheral CD4+ T lymphocytes,Comparison of the expression of Tregs on the 1st day after surgeryin group G and group C(5)G and C groups were classified according to whether the MMSE score decreased by≥2 points on the first postoperative day,and were divided into postoperative cognitive dysfunction group(P group)and non-occurring group(NP group).P group and NP group were compared.CD4+CD25+CD127-Tregs accounted for the proportion of peripheral CD4+ T lymphocytes.Results(1)There were no significant differences in the age,gender,BMI,years of schooling,preoperative MMSE scores,and operative time between the two groups(P>0.05);(2)Comparison of doses of propofol remifentanil,G group was significantly higher than thatin the C group using propofol and remifentanil.The difference between the groups was statistically significant(P<0.05);(3)The incidence of POCD: Compared with the same observation time point,the incidence of POCD in group C was significantly lower than that in group G,and the difference between the groups was statistically significant(P<0.05).;(4)Detection of Tregs: The proportion of CD4+CD25+CD127-Tregs in CD4+ T lymphocytes in venous blood was measured by flow cytometry.The proportion of G and C in preoperative group was the same.The difference was significant(P>0.05).The results of the first day after operation showed that the proportion of group C and group G was significantly higher than that of 1 day before operation.The difference was statistically significant(P<0.05).The proportion of the first day the G group was significantly higher than that of the C group(P<0.05);(5)The CD4+CD25+CD127-Tregs in the venous blood CD4 in the NP group and the P group on the first day after surgery.Comparison of the proportion of +T lymphocytes:The proportion of Tregs in patients with non-POCD in C and C groups was significantly higher than that in patients with POCD,the difference was statistically significant(P<0.05).Conclusion(1)General anesthesia combined with epidural anesthesia will reduce the incidence of postoperative cognitive dysfunction in elderly patients.Epidural anesthesia can effectively block the nociceptive stimulation in the surgical area and transmit to the center through the spinal cord pathway,protect the neuronal cells,reduce the use of anesthesia combined with epidural anesthesia,and further reduce the anesthetic intravenous drug for POCD Impact.(2)Different anesthesia methods have a certain effect on the expression of Tregs.General anesthesia combined with epidural anesthesia has better analgesic effect,weakened stress level,and less immune response such as release of pro-inflammatory factors,resulting in decreased expression of immunosuppressive Tregs.(3)Tregs may play a role in reducing the occurrence and development of POCD,and provide new ideas for the prevention and treatment of postoperative cognitive dysfunction,but its mechanism needs further study. |
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