Effect Of Whole Course Pain Interventions On Postoperative Depression And Cognitive Dysfunction In Elderly Patients With Gastrointestinal Tumor

AbstractObjective:To study the correlation between postoperative depression and cognitive dysfunction, and to explore the effect of whole course pain interventions on postoperative depression and cognitive dysfunction in elderly patients with gastrointestinal tumor.Methods:After approval of the local ethical committee was obtained, 150 elderly patients (age:60-79 years old; MMSE>24; Depression Scale> 50) with gastrointestinal tumor undergoing selective abdominal surgery were enrolled into this controlled study. They were randomized into controlled group (Group C, n=73) and pain intervention group (Group P, n=77). The patients in Group P received the routine nursing which was combined with whole course pain interventions and those in controlled Group C received routine nursing. The scores of Self-Rating Depression Scale, Visual Analogue Scale, and the Scale of Elderly Cognitive Function at different time points of the patients in both groups were recorded. The dose of postoperative anesthetics, the first time of leaving bed, and the hospitalization time of both groups were also recorded.Results:1. Visual Analogue Scale:The scores at all time points in group C were significantly higher than those in Group P, except the time points of 1h and 72h. (P<0.05)2. The dose of postoperative anesthetics and the postoperative recovery condition:The dose of postoperative anesthetics in Group C was significantly higher than that in Group P, the hospitalization time in Group C was significantly longer than that in Group P.3. Self-Rating Depression Scale:The preoperative scores of Self-Rating Depression Scale in both groups were less than 50, and there were no significant difference between Group C and P. The scores of Self-Rating Depression Scale at 7and 14days after operations in both groups were significantly higher than those before (P<0.05). The scores of patients in Group C at 7and 14days after operations were significantly higher than those in group P (P<0.05)4. The Scale of Elderly Cognitive Function:After screening cognitive function with MMSE, no patient with cognitive dysfunction was found in both groups. The scores of SECF in Group C were significantly lower than those in Group P, except the "Long term memory", "Naming animals" and "Imitating" iterms.5. The scores of Self-Rating Depression Scale at 7 days after operations were negatively correlated with original score and T score of SECF(Group C:r=-0.315, Group P:r=-0.369).Conclusions:1 There was a low grade linear positive correlation between postoperative depression and POCD.2 Whole course pain interventions could relieve the postoperative pain, reduce the dose of postoperative anesthetics, and improve the recovery conditions of patients after operation.3 Incidence rate of postoperative depression and cognitive dysfunction could be reduced by whole course pain interventions in elderly patients with gastrointestinal tumor.