Effects Of Dual-channel Target Controlled Infusion Anesthesia On Geriatric Patients’ Cognitive Function Under Narcotrend Index Guidance

Objective:The aim of this study was to investigate whether the dual-channel target anesthesia under NI guidance was different from the single-channelcognitive function in the elderly.Methods:100 cases of supine non-cardiac surgery undergoing selective general anesthesia in our hospital from October 2016 to June 2017,including 52cases of abdominal surgery and 48 cases of thoracic surgery;patients aged60-80 years;BMI 18-25kg/m~2;ASA gradeⅠ~Ⅲgrade;postoperative hospital stay≥7 days are choosed.Patients were randomly divided into two groups:S group and D group.The anesthesiologist of the S group first selected the propofol initial target concentration(Ceprop)according to clinical experience,and then determined the initial target concentration of remifentanil(Ceremi)according to the following principles:If Ceprop is less than 2.5μg/ml,then Ceremi=3 ng/ml If 2.5μg/ml≤Ceprop≤2.9μg/ml,then Ceremi=3.5 ng/ml;if Ceprop>2.9μg/ml,then Ceremi=4 ng/ml.Intraoperative S group adjusted propofol,remifentanil target concentration according to the formula Ce(m)=Ce(m-1)[1+NI error/K](adjustment rules,see Appendix)).NI was maintained at 26 to 46 with a median value of 40 as the target value.Target concentrations were maintained at a range of 1.0 to 7.5μg/ml for propofol and 2 to 8 ng/ml for remifentanil.In D group the anesthesiologist accordance with the experience to adjust the propofol target concentration and remi fentanil injection rate to keep the anesthesia depth(NI 26 to 46).MMSE score and VAS score were performed at 1 day before operation,3 days after operation and 7 days after operation.Results:A total of 100 cases were collected in this experiment.One patient was lost and one patient refused to follow-up.Finally,98 patients completed the study,including 48 patients in group S and 50 patients in group D.Follow-up found that all patients had no intraoperative awareness.There was no statistical difference in general data between the two groups(P>0.05).The propofol dose was slightly lower in the S group than in the D group(P<0.05).The remifentanil dose was slightly higher in the S group than in the D group(P<0.05).Compared with before surgery,after 3 days and 7 days MMSE score in two groups both decreased,were statistically significant(P<0.05).7 days after MMSE score increased,compared with the postoperative 3-day,the score was statistically significant(P<0.05).MMSE scores of S group higher than group D at 3 and 7 days after surgery,there is significant difference(P<0.05).The VAS score was no significant difference between the two groups(P>0.05).Conclusions:NI-guided dual-channel target controlled infusion anesthesia helps protect older cognitive function.