| Objective:To investigate the effects of different doses of hydromorphone on the stress response and postoperative cognitive function in elderly patients with general anesthesia.Methods: Eighty patients undergoing laparoscopic cholecystectomy with general anesthesia from June 2016 to February 2017(ASA I-II,60-75 years old)were randomly divided into group C(control group),group H1(5μg/kg of hydromorphone),group H2(10μg/kg of hydromorphone)and group H3(5μg/kgof hydromorphone).Mean arterial pressure(MBP)and heart rate(HR)before anesthesia(T0),after tracheal intubation(T1),skin incision(T2)and complete surgery(T3),extubation immediately(T4)were observed.The VASscore and Ramsay sedation scoreat 1 hour(T5),4 hours(T6),6 hours(T7),12 hours(T8),24 hours(T9)after surgery,and the side effects during 24 hours after the surgery were compared between the four groups.The cognitive function was evaluated by the Montreal Cognitive Function Assessment Scale(Mo CA)the day before surgery and 24 hours after surgery.The concentrations of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and S100β protein in the sample serumwere measured by ELASA method before anesthesia(T0),1 hour(T5),6 hours(T7),24 hours(T9)after the surgery.Results: 1.General information: There was no significant difference in gender ratio,age,BMI,operation time between four groups(P> 0.05).2.There were no significant differences in MBP and HR between the four groups before anesthesia,skin incision,complete surgery,extubation immediately(P> 0.05).MBP and HR in the group H2 and H3 after tracheal intubation were significantly higher than those in the group C and group H1(P<0.05).3.VAS score(1)The VAS scores of the four groups at6 hours after surgery were higherthan that at 1 hour after surgery,there was statistical significant(P<0.05).(2)The VAS score of group H1,H2 and H3 on time points after surgery was significantly lower than that of group C(P<0.05);the VAS score of group H2 and H3 on time points after surgery was significantly lower than that of group H1(P<0.05);the VAS score of group H3 were lower than that group H2 except 24 hours after surgery(P<0.05).4.Ramsay score: There was no statistical significant in the Ramsay sedation score of the four groups(P> 0.05).5.The concentration of serum IL-6(1)Serum IL-6 concentration of the four groups at6 hours after surgery were higherthan that beforeanesthesia,there was statistical significant(P<0.05).(2)Serum IL-6 concentration of the four groupswere no significant differencebeforeanesthesia(P>0.05).Serum IL-6 concentration of group H1,H2 and H3 on time points after surgery was significantly lower than that of group C(P<0.05);serum IL-6 concentration of group H2 and H3 on time points after surgery was significantly lower than that of group H1(P<0.05);serum IL-6 concentration of group H3 were lower than that group H2 except 24 hours after surgery(P<0.05).6.The concentration of serum TNF-α(1)Serum TNF-α concentrationofthe four groups at6 hours after surgery were higherthan that beforeanesthesia,there was statistical significant(P<0.05).(2)Serum TNF-α concentration of the four groupswere no significant differencebeforeanesthesia(P>0.05).Serum TNF-α concentration of group H1,H2 and H3 on time points after surgery was significantly lower than that of group C(P<0.05);TNF-α concentration in group H2 was lower than that of group H1 at 1 and 6 hours after surgery and TNF-α concentration of group H3 was lower than that of group H1 at 1,6 and 24 hours after surgery;TNF-α concentration of group H3 was lower than that of group H2 only at 1 hour after surgery(P<0.05).7.The concentration of serum S100β protein(1)Serum S100β protein concentrationofthe four groupsat6 hours after surgery were higher in than that beforeanesthesia,there was statistical significant(P<0.05).(2)Serum S100β protein concentration of the four groupswere no significant differencebeforeanesthesia(P>0.05).S100β protein concentration of group H1,H2 and H3 on time points after surgery was significantly lower than that of group C(P<0.05);S100β protein concentration of group H2 and H3 on time points after surgery was significantly lower than that of group H1(P<0.05).8.Mo CA score: The Mo CA score of the four groupswere no significant difference the day before surgery(P>0.05);The Mo CA score of the four groups after surgery was lower than that of preoperative(P<0.05).Mo CA score of group H1,H2 and H3 at 24 hours after surgery was higher than that of group C(P<0.05).9.The side effect: The incidence of emergence agitation of group H2 and H3 were significantly lower than in group C(P<0.05),the incidence of nausea and vomiting of group H3 was significantly higher than that of group C(P<0.05).There was no significant difference in the incidence of skin itching,respiratory depression,urinary retention and constipation diarrhea during 24 hours after surgery(P>0.05).Conclusion: 1.Preoperative intravenous injection of 10μg/kg of hydromorphone is superior than 5 μg/kgof hydromorphonein analgesiaand less than 15μg/kg of hydromorphone in postoperative adverse effectsfor elderly patients undergoing laparoscopic cholecystectomy with general anesthesia in analgesia and postoperative adverse effects,and it does not affect the quality of recovery;2.Preoperativeintravenous injection of hydromorphonecan reduce the release of TNF-α and IL-6,and it can effectively inhibit stress response of anesthesia and surgery;3.Preoperativeintravenous injection of hydromorphone can reduce the incidence of postoperative cognitive dysfunction in elderly patients with general anesthesia. |
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