Effect Of Penehyclidine Hydrochloride On Early Cognitive Function In Elderly Patients After Laparoscopic Cholecystectomy

Objective: To observe the effect of penehyclidine hydrochloride(PHC) applied before anesthesia on early cognitive function in elderly patients after laparoscopic cholecystectomy(LC).Methods: 60 elderly patients undergoing elective LC, ASA grade I ~ II, aged 65-80, were randomly divided into three groups, i.e. groups P1, P2, and N. PHC(0.01 mg·kg-1, and 0.02 mg·kg-1, respectively) and the same volume of saline was administered intravenously 30 mins before anesthesia for the three groups, respectively. Combined intravenous-inhalation general anesthesia with endotracheal intubation was adopted. Mini-mental status examination(MMSE) was used to determine the cognitive function in all the tested patients at 2 days before operation, 1 and 3 days after operation, respectively. And the incidence rate of postoperative cognitive dysfunction(POCD) was calculated. Venous blood was collected from all patients just before PHC administration, and one day after the operation. Concentrations of serum S100β protein and neuron specific enolase(NSE) were measured using enzyme-linked immunosorbent assay(ELISA). Visual algetic mimic scale(VAS) was used to score the analgesia 1, and 2 days after operation, respectively.Results: For all groups, the general situation before and during operation is normal, and there was no significant difference in postoperative VAS scores. The incidence rates of POCD 1 day after operation were 15%, 40%, and 10% for group P1, P2 and N, respectively, in which P2 was significantly higher than P1 and N(P < 0.05),while P1 is slightly, but not statistically, higher than N(P > 0.05). No statistical differences were found in either the POCD rate 3 days after operation, or the comparison of serum concentration of S100β before PHC administration(P>0.05) among all groups. Compared with that before treatment, the concentrations of serum S100β were significantly increased in all three groups 1 day after operation(P<0.05), in which P2 is more apparently increased than P1 and N(P<0.05), and no statistical significance was found in comparison between P1 and N(P>0.05). Compared with the NSE concentration among all groups before administration, in which no statistical significance(P>0.05) was found, there was a significant increase 1 day after operation(P<0.05) with no statistical significance among groups.Conclusions: The cognitive function in elderly patients after LC may be partly impaired. Used as a preoperative drug, 0.01 mg·kg-1 PHC does not affect the incidence rate of early POCD in elderly patients. However, both the incidence rate of early POCD and the concentration of serum S100β with the administration of 0.02mg·kg-1 PHC were found to increase significantly.