Effect Of GDFT Combined With Intercostal Nerve Block On Early Postoperative Cognitive In Elderly Patients After Pulmonary Lobectomy

Objective:To investigate the effect of GDFT combined with intercostal nerve block on early perioperative postoperative cognitive dysfunction in elderly patients undergoing lobectomy.Methods:A total of 120 elderly patients,aged 65-85 years old,ASAⅡ～Ⅲ,were selected from the Affiliated Hospital of Chengde Medical university.The patients were divided into four groups by random number table method.GDFT group（group A）,GDFT+intercostal nerve block group（group B）,conventional fluid+intercostal nerve block group（group C）,and conventional fluid group（group D）（n=30）.The serum levels of interleukin-6,interleukin-10 and tumor necrosis factor were determined by ELISA（enzymed-linked immunosorbent assay）after central venous blood was taken before induction,after surgery and 24h after surgery.Mean arterial pressure and heart rate were recorded at entry（T₀）,immediately after intubation（T₁）,beginning of one lung ventilation（OLV）（T₂）,beginning of surgery（T₃）,end of OLV（T₄）,and after surgery（T₅）.Postoperative VAS score;MMSE scale and MoCA scale were used to evaluate cognitive function.Results:1.Comparison of inflammatory factor levels in the four groups at different time points:There was no significant difference in preoperative IL-6,IL10,TNF-αlevels among the four groups（P>0.05）.2.After the operation and 24h after operation,IL-6,IL10 and TNF-αconcentrations in group B were significantly lower than those in group A,C and D.Group D was higher than group A,B and C（P<0.05）.There was no significant difference in AC between the two groups（P>0.05）.The concentration levels of IL-6,IL10 and TNF-αwere significantly higher at24h after surgery than after surgery（P<0.05）.After operation,the concentration level was significantly higher than that before operation（P<0.05）.3.Comparison of postoperative VAS scores among the four groups:the VAS scores at 2h,12h and 24h after operation were significantly lower in group B than in groups A,C and D（P<0.05）,and higher in group D than in groups A and C（P<0.05）.4.Comparison of MMSE and MoCA scores among the four groups:There was no significant difference in preoperative MMSE and MoCA scores among the four groups（P>0.05）.The score of group B was higher than that of group A and C 1 and 7 days after surgery（P<0.05）.Group D was higher than group A,B and C（P<0.05）.5.Comparison of the incidence of postoperative cognitive dysfunction among the four groups:There was no statistical significance in the incidence of preoperative and postoperative cognitive dysfunction among the four groups.（P>0.05）.The incidence of postoperative cognitive dysfunction in group B was lower than that in group A,C and D at 7 and10 days after surgery.Group D was higher than group A and group C（P<0.05）.Conclusions:GDFT combined with intercostal nerve block can effectively reduce perioperative inflammatory factors,relieve postoperative pain and reduce the incidence of postoperative cognitive dysfunction in elderly patients with lobectomy...