The Influence On Early Cognitive Function In Elderly Patients With Gastrointestinal Cancer After Different Anesthesia

Objective:By comparing different impacts on early cognitive function in elderly patients with gastrointestinal cancer after surgery to facilitate the clinical work, to choose safer anesthetic techniques in elderly patients with gastrointestinal tumors for convenient clinical need.Methods:90cases of elective gastrointestinal tumor patients (ASA<III), including the esophagus, cardia, stomach, colon, rectal cancer, age60to79years old, body weights (45-85) kg, can have effective communication with physicians and MMSE scores>24points. The standard of case exclusion:Patients with preoperative nerve, history of psychiatric disorders, taking the appropriate drugs, impaired renal function and active liver disease can not participate in this study. Using random number table, patients were randomly divided into3groups (n=30): Propofol TIVA group (P group); inhalation combined group (SP group), sevoflurane and propofol, sevoflurane inhalation anesthesia group (S); the same period patient non-surgical patients,30cases as control group (C group) and all patients had no preoperative drugs.Three groups of patients using the same anesthesia induction,4to6ug/kg fentanyl, propofol2mg/kg, followed by slow intravenous injection of rocuronium0.6mg/kg. Anesthesia was maintained by the mode following:the P group received intravenous infusion of propofol (3to6mg kg-1· h-1); SP group patients inhaled sevoflurane1%+propofol (3to6mg· kg-1· h-1); sevoflurane in group S were1-3%. Recording each group of the patient’s age, gender, height, weight, years of education, general complications, duration of anesthesia, surgery type, liquid total income amount, respectively, and in preoperative1d, the anesthesia recovery room after surgery,3and7days, using the MMSE (minimental state examination, MMSE), scale cognitive function score, total score of30points, down more than2points for the cognitive decline. The POCD determine cognitive dysfunction, the use of Z-scoring method, and Z=(△X-△XC)/SD (△XC), Z scored≥1.96, that patients with POCD. Three groups of patients were the day before surgery and postoperative Id venous blood5ml using enzyme-linked immunosorbent assay (ELISA) method, determination of IL-1β, IL-6, operating in accordance with the instructions of the ELISA kit.Results:Compared with group C, MMSE score decreased (P<0.05) in group P,SP and S group when leaving the anesthesia recovery room Id after, and incidence of cognitive dysfunction (P<0.05)increased;compared with preoperative in group P, Sp and S group leaving the PACU, MMSE score was lower (P<0.05) in postoperative1d; and there was no significant difference among the three groups; although there was slightly decreased in3and7days after the operation compared with the preoperative, the difference was not statistically significant (P<0.05). IL-6, IL-1β1d after was significantly higher (P<0.05) than before surgery1d, and there was no statistically significant differences between groups..Conclusions:Anesthesia in elderly patients after gastrointestinal cancer surgery when leaving recovery room, cognitive function at postoperative day1declined, and basically recovered three days to seven days after. There was no difference in the anesthesia among the way of three kinds of cognitive dysfunction, which provided a variety of options for clinical senile anesthesia. Excessive Gastrointestinal tumors surgical stimulation and inflammatory cytokines may have an impact on postoperative cognitive function.