The Effect Of Preoperative Anesthesia Health Education On The Quality Of Recovery In Elderly Patients And Early Postoperative Cognitive Function

Objective: To observe the effect of preoperative anesthesia health education on the quality of recovery in elderly patients and early postoperative cognitive function.Methods: From September 2020 to January 2021,at the Affiliated Tumor Hospital of Guangxi Medical University,Forty patients who underwent VATS wedge-shaped lung resection or lobectomy or radical resection of lung cancer,ASA grade I to II,aged 65 to 75 years old.Divided into two groups,The control group routinely conducted pre-anaesthesia visits(1.Obtain relevant medical history,including current medical history,personal history,past history,allergy history,surgical anesthesia history,and drug application history,etc.,physical examination laboratory examinations,special examinations and patient mental status The data and the planned operation are analyzed and judged to improve the preoperative preparation and formulate a suitable anesthesia plan.2.Instruct the patient to cooperate with anesthesia,answer related questions,relieve the patient’s anxiety and fear,and gain the patient’s trust.3.According to the specific situation of the patient,reach a consensus with the surgeon on the risks of anesthesia and surgery and how to cooperate.4.Communicate well with the patient,introduce the anesthesia method and anesthesia process in easy-to-understand terms,and sign an anesthesia informed consent form).In addition to the regular pre-anaesthesia visits in the observation group,the anesthesiologist visited the patients one day before the operation and explained anesthesia health education to them: mainly introduce the anesthesia and the operating room in easy-to-understand language(according to the following content Carry out expansive and easy-to-understand communication): 1Overview of anesthesia: 1-1: Definition of anesthesia-popular explanation The use of anesthetic drugs makes the patient lose feeling and can tolerate the state of the operation.1-2: The relationship between anesthesia and surgery-Anesthesia and surgery are closely related,and the anesthesiologist is responsible for the life control during the operation to ensure the safe operation of the operation.1-3: Importance of preparation before anesthesia: to enhance the patient’s tolerance to anesthesia and surgery,avoid accidents of anesthesia,reduce complications of anesthesia,and improve perioperative safety.2Anesthesia methods: 2-1: the definition of general anesthesia : Anesthetics enter the patient’s body through inhalation,or intravenous injection or intramuscular injection,and inhibit the central nervous system to achieve loss of consciousness,no pain,forgetting,reflex inhibition and skeletal muscle relaxation.2-2: Reasons for choosing general anesthesia: It is convenient for the management of this operation,single-lung ventilation,to ensure that the surgeon can operate on the affected lung and perform the operation safely and smoothly.2-3: Other anesthesia methods: local anesthesia,regional nerve block,intraspinal anesthesia,etc.3 Preparation of preoperative evaluation results: 3-1: Pre-anaesthesia evaluation content(current symptoms,medical history,life background,auxiliary examinations,experiments Laboratory examination,airway assessment) 3-2: The purpose of the assessment: To understand the basic situation of the patient’s solution,to assess whether the patient can tolerate the operation and anesthesia,whether it is necessary to improve other examinations,and improve the safety of the perioperative period.4 Pre-operation preparation: 4-1: Routine preparation: 8 hours of fasting before operation and no drinking for 4 hours to prevent perioperative reflux and aspiration 4-2: General preparation: changing the gown,removing body items,ring and earrings 4-3: Special preparations:smoking(quit smoking for more than two weeks),loose teeth(to avoid tooth loss during the perioperative period),dentures(can be taken out before surgery)5 general conditions of the operating room: 5-1: surgeon,Anesthesiologist,instrument nurse,itinerant nurse.6 Overview of events before receiving anesthesia: 6-1: How to go to the operating room 6-2: Three-party verification and verification of identity 6-3: Connect monitoring equipment(ECG,pulse oxygen saturation,non-invasive blood pressure)6-4: Establish deep veins,establish Arteries(and explain the necessity and location of establishment and related possible complications)7 Induction of anesthesia: 7-1: Inducing drugs:(sedation,analgesia,muscle relaxation)Route of administration 7-2: Airway Management: Purpose,mask ventilation,placement of a double-lumen endotracheal tube under visual laryngoscope,mechanical ventilation 8anesthesia maintenance: 8-1: intraoperative anesthetic maintenance 8-2:intraoperative vital signs regulation and stability 8-3: Blood loss and blood transfusion 8-4: Intraoperative heat preservation 9 Anesthesia and resuscitation room experience: 9-1: Transfer to the resuscitation room for resuscitation after the operation,and regain consciousness in the resuscitation room.9-2: Airway management during resuscitation(extubation indications,extubation time,possible experience during the peri-extubation period)cooperate with the anesthesiologist.9-3: Resuscitation room monitoring: monitoring of breathing and circulation 10 Return to the ward after resuscitation,and explain the precautions that the patient and family members need to pay attention to after returning to the ward.The responsibilities of the anesthesiologist and answer the questions raised by the patient and answer patiently,and at the end ask the patient about the degree of understanding of the relevant introduction and send the patient a hard copy of the anesthesia-related introduction.inutes.Anesthesia induction: The two groups of induction methods were the same,midazolam0.03mg/kg,fentanyl 3ug/kg,propofol 2mg/kg,and cis-atracurium 0.15mg/kg anesthesia induction.A double-lumen endotracheal tube was inserted into the trachea through oral vision,mechanical ventilation,VT6 ~ 8ml/kg,I:E1:2,RR:12~18 times/min,PEEP≤5cm H2 O,maintain PETCO2 at 30~45mm Hg,airway Pressure <35cm H2 O.Anesthesia maintenance: Intravenous anesthesia is used for maintenance,propofol,remifentanil,and cis-atracurium are used to maintain anesthesia.The depth of anesthesia is adjusted according to BIS during the operation,and the BIS value is maintained in the range of 40-60.It is expected The cis-atracurium was stopped 30 minutes before the end of the operation.After the operation,the patient will be sent to the anesthesia recovery room for recovery.Observation indicators: The patient’s cooperation with doctors and nurses and the degree of cooperation between the patient and the doctors and nurses during the awakening stage from anesthesia(the stage from entering the resuscitation room to the opening of the eyes)and before the tracheal tube is removed and after the tracheal tube is removed.,0 means that the patient is violently restless,struggling and uncooperative,and requires external braking or deepening the depth of anesthesia;1 means that the patient is struggling slightly,but does not require external braking or deepening the depth of anesthesia;2 means that the patient and doctors and nurses are fully cooperative,and are The nurse’s words can be coordinated,follow up patients after 24 hours to ask about satisfaction.And collect the resuscitation room into the resuscitation room T1,eyes open T2,T3 when extubation,T4 after extubation,T5 out of the resuscitation room,heart rate and five time points Mean arterial pressure.The patients in both groups had MMSE scores on the day before the operation,the first day after the operation,the second day after the operation,and the third and third day after the operation.Both groups of patients underwent VAS pain scores on the first day after surgery and the third day after surgery.Results:1.The general conditions of the two groups of patients were not statistically significant in age,gender,height,weight,operation duration,infusion volume,and fluid output(P>0.05).2.There was no statistically significant difference in extubation time and anesthesia satisfaction between the two groups(p>0.05).3.There was no statistically significant difference in the quality of resuscitation from anesthesia and the degree of cooperation in the awakening stage of anesthesia(p>0.05).Before and after tracheal tube removal,the degree of cooperation in group C was significantly lower than that in group X,and the difference was statistically significant(p <0.05),4.At T1~T5,the difference in mean arterial pressure between the two groups of patients was not statistically significant(p>0.05);at T1~T2,the heart rate of group C was higher than that of group X,but the difference was not statistically significant Significance(p>0.05).At each time point from T3 to T5,the heart rate of group C was significantly higher than that of group X,and the difference was statistically significant(p<0.05).5.MMSE score,one day before surgery,the first day after surgery,On the second day after the operation and the third day after the operation,the group C was lower than the group X,but the difference between the day before and the first day after the operation was not statistically significant(p>0.05).The second day after the operation and the first day after the operation were not statistically significant(p>0.05).The three-day difference was statistically significant(p<0.05).The incidence of postoperative cognitive dysfunction on the second day and the third day after surgery was significantly higher in group C than in group X,and the difference was statistically significant.Comparison of preoperative and postoperative MMSE scores within the group,the MMSE scores of the missionary group and the non-missionary group both showed a downward trend.The difference between the day before the operation and the first,second and third days of the non-missionary group was statistically significant(P<0.05),the difference between the day before the operation and the first and second days after the operation in the missionary group was not statistically significant(P>0.05),and the difference between the day before the operation and the third day after the operation was statistically significant(P<0.05).There was no statistical difference in the pain scores between the two groups of patients on the first day after the second day after the operation and the third day after the operation(P>0.05).Conclusions: 1.Anesthesia health education before thoracoscopic wedge resection or partial lung resection or radical lung cancer surgery can increase the patient’s degree of cooperation with medical care during resuscitation 2.Preoperative anesthesia health education can reduce the reduction of the patient’s postoperative MMSE score...