| Objective:To give a dose of hydrochloric acid nalmefene by intravenous injection way before induction of general anesthesia and observe its effect on postoperative cognitive function(Post operative cognitive dysfunction POCD)and adverse reactions during awaking of the elderly patients of laparoscopic cholecystectomy under general anesthesia,in order to improve the elderly patients postoperative cognitive function(Post operative cognitive dysfunction POCD)or provide methods of reducing the incidence of POCD.Methods: Choose 140 cases of patients with gallbladder stones,cholecystitis,from October 2018 to December 2019,consistent with the inclusion criteria and exclusion criteria,ASA Ⅰ ~ level Ⅱ.They are carried out in accordance with the anaesthesia operation sequence number: 1~140,using SPSS20.0,1~140 patients were randomly divided into group of hydrochloric acid nalmefene(experimental group)and group normal saline(control group),each 70 cases.Push note 0.50 ug/kg hydrochloric acid nalmefene and 2 ml of physiological saline into experimental group and control group respectively 5 min before the induction of general anesthesia by intravenous,then perform oxygen inhalation by mask,oxygen flow rate of 5 l/min,5 min after induction of general anesthesia: experimental group and control group were given midazolam 0.04~0.05 mg/kg,sufentanil 0.35~0.40 ug/kg,cis atracurium 0.15~0.20mg/kg,0.20~0.30mg/kg,etomidate sufentanil slowly push note(time for 1 min),observed during anesthesia induction dosing and two groups of patients induced choking cough response is happening;Endotracheal intubation was performed under visual laryngoscope 2 ~3min after induction of anesthesia,and changes in MBP and HR before and after intubation were observed and recorded.Intravenous anesthetics were used for maintenance of anesthesia in both groups.During anesthesia,SBP was maintained above90 mmHg or decreased by no more than 20% of the baseline value,and below this threshold dopamine was given 1mg/ time,HR 55 times/min or above the baseline heart rate,and below this threshold isoproterenol was given 1ug.The administration of muscle relaxant and sevoflurane was stopped 30 min before the end of the operation.5min before the end of the operation,the patients were given PCIA analgesia pump: 5mg tropisetron,6mg granisetron,1ug/kg sufentanil,and 100 ml normal saline.Setting of analgesic pump:the load is 1.8ml,the locking time is 15 min,the continuous dose is 2ml/h,and the automatic control dose is 1.8ml/ time.To observe the occurrence of adverse reactions in the patients’ awakening period after the completion of anesthesia operation;The score changes and POCD occurrence of the two groups were evaluated and compared using MMSE and TICS-m.Results:1.There was no statistically significant difference between the two groups in general conditions(sex ratio,age,height,weight,operation time and education level)(p> 0.05).2.The incidence of group of hydrochloric acid nalmefene cough choking reaction was 8.33% and the incidence of group normal saline cough choking reaction was75.00%,the incidence of cough choking reaction significantly lower in the experimental group than in the control group(p < 0.05).3.There was no statistically significant difference in MBP and HR between the two groups in five minute after entering operating room and before and after endotracheal intubation(p > 0.05).4.Two groups of patients with preoperative and postoperative 1 day,1 day after 3days,5 days and 15 days after the MMSE,TICS-m rating scale comparison: 1 day MMSE respectively with preoperative,TICS-m rating scale,compared two groups of patients in postoperative 1 day,3 days after operation,postoperative 5 days are decreased,the control group,the more significant the experimental group and the most significant the 5 days after surgery;There was no difference in MMSE and tcis-m scale scores between the two groups at 15 days after surgery and 1 day before surgery(p > 0.05).There were statistically significant differences in MMSE scores between the two groups at 3 and 5 days after surgery,(p< 0.05);There were statistically significant differences inTICS-m scores between the two groups at day1、day3 and 5 days after surgery(p< 0.05).5.POCD incidence was assessed by MMSE and TICS-m scale: when POCD was assessed by MMSE scale,1 case occurred 5 days after surgery in the test group,9 cases,13 cases and 1 case occurred 3 days after surgery,5 days after surgery and 15 days after surgery in the control group,and the incidence of POCD was 15.00%,21.67% and 1.67%,respectively.When POCD was assessed using the TICS-m scale,1 case occurred 5 days after surgery in the test group,1 case,9 cases,14 cases and 1 case in the control group,respectively,1 day after surgery,3 days after surgery,5 days after surgery and 15 days after surgery.The incidence of POCD was 1.67%,15.00%,23.33% and 1.67%,respectively.The incidence of POCD in the experimental group was significantly lower than that in the control group at 3 and 5 days after surgery(p < 0.05).6.The incidence rates of restlessness,nausea,vomiting,respiratory depression and other adverse reactions in the experimental group were significantly lower than those in the control group(p < 0.05).Conclusion:1.Nalmefene can effectively reduce the incidence of cough reactions and adverse reactions in the recovery period.2.Intravenous injection of a certain amount of nalmefene before general anesthesia can improve the postoperative cognitive function of middle-aged and elderly patients,reduce the early incidence of POCD,and play a certain role in prebrain protection,so it is worth popularizing. |
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