ABSTRACT
Objective To investigate the effect of anesthesia at different depths on postoperative cognitive disfunction (POCD) and inflammatory response in the elderly patients undergoing abdominal operation.Methods A total of 90 elderly patients who underwent abdominal operation in the Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2014 to June 2016 were divided into observation group and control group according to the depth of anesthesia,45 cases in each group.The patients in the two groups were performed with combined intravenous and inhalation anesthesia,the bispeetral index (BIS) value was maintained at 30-39 during the operation in the observation group,and the BIS value was maintained at 50-59 during the operation in the control group.The mean arterial pressure (MAP) and heart rate(HR) of patients in the two groups were recorded at the time points of entering the operation room(T0),5 minutes after tracheal cannula(T1),opening abdominal cavity (T2),closing abdominal cavity (T3) and tracheal cannula extubation (T4).The mini-mental state examination (MMSE) score of the patients in the two groups was performed before operation and the first,third,seventh day after operation;and the incidence of POCD was recorded.The levels of serum interleukin-6(IL-6) and S-100β protein were detected at the time points of before operation,the end of the operation and the first,third day after operation in the two groups.Results Five cases in the control group and six cases in the observation group were eliminated,39 cases in the observation group and 40 cases in the control group were evaluated finally.The MAP at T1 and T2 was significantly lower than that at T0 in the two groups (P ＜ 0.05).There was no significant difference in the MAP between T3,T4 and T0 in the two groups(P ＜ 0.05).There was no significant difference in the HR each time point in each group(P ＜ 0.05).There was no significant difference in the MAP and HR between the two groups at each time point(P ＜ 0.05).There was no significant difference in the MMSE score between the two groups before operation(P ＜ 0.05).The MMSE score of patients at the first and third day after operation was significantly lower than that before operation and the seventh day after operation in the two groups (P ＜ 0.05).There was no significant difference in the MMSE score between before operation and the seventh day after operation in the two groups(P ＜0.05).The MMSE score in the observation group was significantly higher than that in the control group at the first and third day after operation (P ＜ 0.05).There was no significant difference in the MMSE score between the two groups at the seventh day after opera tion(P ＜ 0.05).The incidences of POCD at the first,third and seventh day after operation in the observation group were 28.21％ (11/39),15.38％ (6/39) and 7.69％ (3/39) respectively;and they were 50.00％ (20/40),37.50％ (15/40) and 20.00％ (8/40) respectively in the control group.The incidence of POCD in the observation group was significantly lower than that in the control group at the first and third day after operation (x =3.934,4.949;P ＜ 0.05).There was no significant difference in the incidence of POCD between the two groups at the seventh day after operation(x2 =2.496,P ＜ 0.05).There was no significant difference in the levels of serum IL-6 and S-100β protein between the two groups before operation (P ＜0.05).The levels of serum IL-6 and S-100β protein at the end of operation and the first,third day after operation were significantly higher than those before operation in the two groups(P ＜ 0.05).The levels of serum IL-6 and S-100β protein in the observation group were significantly lower than those in the control group at the end of operation and the first,third day after operation (P ＜ 0.05).Conclusion Deep anesthesia (BIS value is maintained at 30-39) can reduce the levels of inflammatory factors,the incidence of POCD after operation and the brain damage in the elderly patients with abdominal operation.