The Effects Of Sevoflurane Combined With Propofol Intravenous Anesthesia On Early Postoperative Cognitive Dysfunction In Elderly Patients After Laparoscopic Cholecystectomy

Objective:The present study was designed to investigate sevoflurane combined with propofol intravenous anesthesia on the occurrence of early postoperative cognitive dysfunction(POCD) in elderly laparoscopic cholecystectomy patients, and to observe the influence of different General anesthesia methods What is said above on the Hemodynamic (oxygen, blood pressure, heart rate) in elderly patients undergoing laparoscopic cholecystectomy.Methods:Select forty laparoscopic cholecystectomy cases of Shangdong Province-owned Hospital affiliated to the Shandong University, ASAI-Ⅱ grade, age61-80years old, divided into two groups by the computer random number table:Group A (total intravenous anesthesia group) and group B (intravenous inhalational anesthesia group),20cases of each group. All patients were given penehyclidine hydrochloride0.01mg/kg by intravenous in half an hour before the operation.And given10minutes to complete the injection of lug/kg dexmedetomidine hydrochloride by infusion pump before the induction of anesthesia. The anesthesia induction method of all of the two groups patients was used intravenous anesthesia induction.All patients had been received midazolam0.04mg/kg,cisatracurium besilate0.3mg/kg,fentany5ug/kg,etomidate0.25mg/kg,esmolol0.5mg/kg for anesthesia induction. Then tracheal intubation was performed by an experienced anesthesiologist, ensure the success rate of intubation. Maintenance of anesthesia for total intravenous group adopted TCI model with continuous infusion of propofol sedation, cisatracurium besilate0.1mg/(kg·h) maintain muscle relaxation, intravenous-inhalation group continued to pump into the drugs, combined with inhalation of sevoflurane concentration maintained below2%.The dosage and speed of propofol and the Inhaled concentration of sevoflurane was determined by the NI(Narcotrend Index, NI),which should be controlled between D1and E1.And fentany2ug/kg was given to all patients at the beginning of skin incision and the following operation each hour. Record the mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) in TO (Into the operation room), T1(intubation), T2(skin incision), T3(closed abdominal), T4(extubation). Mini-Mental State Examination score(MMSE) and Self-rating Depression Scale(SDS) were tested on the day before the operation when I visited patients. Wechsler Adult Intelligence Scale(WAIS) and Wechsler Memory Scale(WMS) were measured one day before operation,one day after operation,three days after operation and seven days operation.Then complete the assessment according to the Z-combined score method which is recommended by International Study of Postoperative Cognitive Dysfunction (ISPOCD).Result:1.There were no significant differences in the aspects of fundamental state MMSE and SDS test.(P>0.05).2.Comparison of hemodynamic indexes of two groups at different time points (MAP, HR, SpO2):Two groups of patients in the heart rate (HR) and oxygen saturation (SpO2) were not statistically significant within group and between groups, P>0.05. The difference of total intravenous group at different time points of mean arterial pressure (MAP) had statistically significant,P<0.05.Mean arterial pressure in T2when compared with TO increased significantly, the difference was statistically significant, P<0.05, the rest of the time points (T1, T3, T4) compared with TO had no significant differences, no statistically significant, P>0.05. The difference of intravenous inhalational anesthesia group at different time points of mean arterial pressure (MAP) also had statistically significant, P<0.05. MAP in T1compared to TO decreased significantly, the difference had statistically significant, P<0.05, the rest of the time points (T2, T3, T4) compared with TO had no significant differences, no statistically significant, P>0.05. But the mean arterial pressure (MAP) of two groups were no difference between the two groups, there was no statistical significance, P>0.05.3.There were3,1,0cases appeard POCD after1days,3days,7days of operation in total intravenous group patients, the incidence was15%,5%,0%. And there were2,0,0cases appeard POCD after1days,3days,7days of operation in intravenous inhalational anesthesia group patients, the incidence was10%,0%,0%, But there was no statistical significance between the two groups, P>0.05.Conclusion:Total intravenous group compared with intravenous-inhalation group, the latter can be reduced the incidence of POCD in elderly patients after laparoscopic cholecystectomy, but no statistical significance.