| Background:Digestive endoscopy has been widely used all over the world since its inception,It can enable gastroenterologists to directly diagnose and treat some common gastrointestinal diseases.Early gastric cancer and colorectal cancer can be detected and treated in a timely manner.It greatly improves the probability of early diagnosis and treatment of gastrointestinal tumors and prolongs the survival period of patients.Painless technology can significantly increase the tolerance of gastroenteroscopy,so that patients can complete the whole examination and treatment in a painless state,improving comfort,so it is widely used in clinic.However,after painless gastroenteroscopy,many patients complained of memory loss,slow reaction and other suspected symptoms of cognitive dysfunction,which aroused the concern of gastroenterologists.Postoperative cognitive dysfunction refers to the significant reduction of patients’mental,personality,activities and cognitive ability after anesthesia and surgery.Its main clinical manifestations are memory,attention,language comprehension and other impairment of social skills.POCD can happen for days to weeks after surgery,also may continue for a long time,increase mortality,delayed recovery,complications,hospitalization days and obviously increase the medical expense,etc.POCD does serious harm to patients,families and society.Short-term POCD occurs within 7 days after surgery,and long-term POCD are present within 3 months after surgery,short-term POCD is more common.Currently,there is no unified definition of POCD,but it has attracted more and more clinical attention.Objective:Many patients especially elderly patients complained of memory loss after painless gastroenteroscopy,with symptoms of suspected POCD.So in this research patients undergoing painless gastroenteroscopy with propofol combined with fentanyl were selected as subjects,evaluating the changes of cognitive function before and after operation,then investigating the effect of endoscopy under intravenous anesthesia on cognitive function.And make a preliminary analysis of effect of different age,education level,the dosage of propofol anesthesia,duration of anesthesia on cognitive functionMaterials and methods:Recruiting 54 patients who underwent painless gastroenteroscopy in the Second Affiliated Hospital of Zhejiang University School of Medicine from August 2018(Number A001-A054).Using HAD scale(Hospital Anxiety and Depression Scale)to screen emotional state within 3 days before operation(T1),2-4 hours after postoperative awake(T2),1 week after operation(T3),3 months after operation(T4)(±3 days).Then cognitive function was measured using Montreal Cognitive Assessment(MoCA),Digit Span Test(DST),Digit Symbol Substitution Test(DSST)and Wisconsin Card Sorting Test(WCST).SPSS 20.0 statistical software was used for statistical analysis of all data.Paired data T test was used for statistical analysis(if the paired design was not successful,it was changed to group T test),and anova of repeated measurement design was used.P<0.05 was considered statistically significantResults:In patients undergoing painless gastroenteroscopy under combined anesthesia with propofol and fentanyl,10%of patients developed POCD within 2-4 hours after surgery(5/50),and recovered to the preoperative level 1 week after surgery.There was no significant difference in patients’ DST scores at different times before and after surgery,while MoCA,DSST and WCST scores were significantly better than preoperative level(P<0.05).In the subgroup analysis,MoCA scores of T2 in patients of different age groups,propofol dose,duration of anesthesia,and education level did not decrease significantly compared with T1.Conclusions:1.Propofol combined with fentanyl used in painless gastroenteroscopy in the department of gastroenterology is safe and has good anesthesia effect,but transient postoperative cognitive dysfunction can still occur,the incidence rate is about 10%,and it will returns to the preoperative level 1 week after surgery.2.Age,propofol dose,duration of anesthesia and education level have not been found to have different effects on cognitive function after painless gastroenteroscopy.But patients with POCD in this study were all over 48 years old,and below 11 years of education.Therefore,it is recommended that patients over 48 years old and with low education level(less than 11 years,that is,less than high school education)who need painless gastroenteroscopy should closely be accompanied by families,pay attention to the memory and attention within 1 week after surgery,and make important decisions cautiously. |
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