Effects Of Enhanced Recovery After Surgery Pathway Application On Early Cognitive Function Of Patients After Laparoscopic Colorectal Resection

Objective:To observe and investigate the effects of enhance recovery after surgery（ERAS）strategy through a series of optimization on early cognitive function of patients after laparoscopic colorectal resection.Methods:Sixty patients undergoing laparoscopic colorectal resection in the Harrison International Peace Hospital,were randomly divided into two groups（n=30 each）:group E and group C.Patients in group E accepted perioperative and anaesthetic optimization of enhanced recovery after surgery pathway,and patient in group C received management of normal surgery concept.Group E performed perioperative management of medical care,enhanced preoperative education,smoking cessation and respiratory function training,given nutritional support and consumed carbohydrate-rich fluid 800ml 12 hours before anesthesia,and consumed fluid 400 ml 2 to 3 h before anesthesia.Anesthesia was performed using general anesthesia combined with continuous thoracic epidural anesthesia.During the operation,A series of enhance recovery after surgery strategies for perioperative management were used to improve recovery.Such as thermal insulation measures,fluid restr-iction,postoperative multimodal analgesia,and encourage early postoperative feeding and ambulation.Traditional routine perioperative management and monitoring methods,rehydration by conventional methods,were used in group C.After the patient of group C was admitted into the room,no heat preservation treatment was performed,the fluid and abdominal irrigation fluid were not heated,no epidural anesthesia was performed,postoperative analgesia was performed using patient-controlled intravenous analgesia（PCIA）.Such parameters as the gender ratio,age,ASA classification,BMI,education level,pathological type,surgical method,operation time,intraoperative fluid input,sufentanil consumption,postoperative eye opening time,extubation time,orientation recovery time in two groups were compared.Cognitive function and T incidence of POCD of patients in the two groups were evaluated using MMSE 1 day before and 1 day,3 days,5 days after surgery.Blood samples from internal jugular veins were collected 1 day before surgery（T₀）,1 hour after surgery（T₁）,6 hours after operation（T₂）,12 hours（T₃）,and 24 hours（T₄）,which were determined the serum content of S100β,NSE,IL-1β,IL-6,and TNF-αby ELISA.The time of PACU after surgery,the time of first eating fluid food,the total number days of hospitalization were recorded.Postoperative complications such as nausea and vomiting,lethargy,agitation and chills were recorded.Results:1.There were no significant differences in the general indicators of gender,age,ASA classification,BMI,education level,pathological type,surgical method,and operation time between the two groups（P>0.05）.2.Compared with group C,the intraoperative fluid input and sufentanil consumption were lower,eyes open time,extubation time and orientation recovery time of group E were significantly shorter（P<0.05）.3.Compared with group C,the MMSE scores in group E at 1day and 3days after operation were significantly higher（P<0.05）.Compared with 1 day before operation,the MMSE scores in group C at 1 and 3 days after operation,and 1 day after operation in group E were decreased significantly（P<0.05）.The incidence of POCD in group E was 1.7%,3.3%,and 3.3%at 1day,3 days and 5 days after operation.While the incidence of POCD in group C was26.7%,16.7%,and 13.3%.Compared with group C,the incidence of POCD in group E was significantly lower at 1 and 3 days after operation（P<0.05）.4.Compared with T₀,the serum levels of S100βprotein and NSE were increased significantly between the two groups at T₁-T₄（P<0.05）.Compared with group C,the content of S100βprotein and NSE in group E from T₁ to T₄were decreased significantly（P<0.05）.5.Compared with T₀,the serum levels of IL-1β,IL-6,and TNF-αwere increased significantly from T₁ to T₄ in both groups（P<0.05）.Compared with group C,the levels of IL-1βand IL-6 in group E were decreased significantly at T₁ and T₂（P<0.05）,and the expression levels of TNF-αat T₁ to T₃ were decreased significantly（P<0.05）.6.Compared with group C,the time of retention in PACU,the time of first eating fluid food,the total number days of hospitalization were decreased significantly in group E（P<0.05）.7.The incidence of adverse reactions such as postoperative nausea and vomiting,lethargy,agitation and chills were significantly lower in group E than in group C（P<0.05）.Conclusion:1.ERAS strategy can improve the quality of postoperative recovery in patients undergoing laparoscopic colorectal resection and accelerate postoperative recovery.2.ERAS strategy is helpful in improving early postoperative cognitive function of patients undergoing laparoscopic colorectal resection,reduce the incidence of early POCD,and its mechanism may be related to decreased the level of S100βprotein,NSE,IL-1β,IL-6 and TNF-α.