| ObjectivePerioperative neurocognitive dysfunction(PND)complicates postoperative recovery and often leads to severe consequences.According to the expert consensus of the American Cognitive Association,perioperative neurocognitive dysfunction is divided into preoperatively diagnosed neurocognitive dysfunction.Postoperative delirium(cognitive impairment within 7 days after operation),delayed neurocognitive recovery(cognitive impairment 7 days to 30 days after operation),postoperative neurocognitive impairment(30 days to 12 months after operation)[1].Among them,the delayed neurocognitive recovery is not only high,but also closely related to the long-term prognosis and mortality of patients,which is the best period for intervention therapy.Delayed neurocognitive recovery is more common in elderly patients,Its pathophysiological mechanism,molecular mechanism and prevention methods are still the focus of discussionin elderly patients.The inhaled anesthetic,sevoflurane,is widely used in general anesthesia.It not only induces anesthesia quickly and easy to use,but also has analgesic and muscle relaxation effects.Previous studies still dispute the relationship between intraoperative sevoflurane inhalation anesthesia and delayed recovery of nerve function in elderly patients.Studies have shown that intraoperative use of inhaled anesthetics may increase the risk of postoperative cognitive dysfunction.The purpose of this paper is to discuss the effect of sevoflurane inhalation on the delayed neurocognitive recovery after arthroplasty in elderly patients.MethodsThis study was designed as a randomized controlled trial,A total of 316 patients underwent arthroplasty in Shandong Provincial Hospital were selected.The patient is over 65 years old,ASA classified as Ⅰ-Ⅲ,and careless,abnormal liver and kidney function.After the patient enters the operating room,based on computer-generated random numbers,were randomly divided into two groups according to the 1:1 ratio:sevoflurane inhalation anesthesia group(S group)and control group(Con group).The two groups opened the venous access,The invasive arterial blood pressure(IBP),heart rate(HR),finger pulse oxygen saturation(SpO2)were detected,electrocardiogram(ECG)and end-expiratory carbon dioxide concentration(PETCO2).Both groups were induced by intravenous anesthesia,anaesthesia induction using etomidate 0.2-0.3mg/kg,of sufentanil 0.3-0.5μg/kg,of cisatracurium 0.2-0.4 mg/kg and of esmolol 0.2-0.3 mg/kg.Anesthesia ventilator controls breathing after intubation.Add sufentanil 0.3-0.4μg/kg analgesia before skin cutting.Intraoperative anesthesia maintenance inhalation anesthesia group with 1-1.5 MAC sevoflurane,continuous infusion of propofol during TCI mode was used in the control group.During the operation,it is necessary to push down atracurium.Intraoperative adjustment of anesthetic maintenance drugs and vasoactive drugs according to hemodynamic changes and surgical stimulation intensity,maintain appropriate anesthetic depth and hemodynamic stability.One day before surgery,seven days after surgery,on the 15th and 30th days,patients were assessed by MMSE and MoCA scales,collect general demographic characteristics and perioperative information of patients,blood was drawn 30 minutes before operation,1 day after operation and 30 days after operation to detect the level of S100β protein in blood.The risk factors of DNR were determined by univariate analysis,and the related factors of DNR were explored by logistic regression analysis and ROC analysis.Results1.There was no statistical difference in general demographic characteristics before operation between the two groups(P>0.05).2.There was no significant difference in preoperative MMSE scale and MoCA scale between the two groups(P>0.05),and no significant difference in plasma S100βprotein level before operation(P>0.05).3.The plasma S100β protein concentration increased on the first day after operation(P<0.05)compared with the first 30 minutes before operation,and the plasma S100βprotein concentration increased in the S group on the first day after operation(P<0.05).4.A total of 88 of 316 patients underwent delayed neurocognitive recovery(DNR),the incidence of DNR was 18.35%.The incidence of DNR in S group was 25.31%(n=40),The incidence of DNR in Con group was 11.39%(n=18).The incidence of DNR in S group was higher than Con group,difference was statistically significant(P<0.05).5.Univariate logistic regression analysis showed that age,neutrophil count and C-reactive protein in preoperative laboratory examination,preoperative ASA grade,and plasma S100 on the first day after operation β Protein concentration and operation duration are risk factors for delayed recovery of neurological function.Conclusions1.According to our results,sevoflurane inhalation anesthesia can increase the incidence of delayed recovery of cognitive function after arthroplasty in elderly patients,which may be related to inflammatory response and plasma S100β protein concentration.2.Age,preoperative neutrophil count and operation duration were independent risk factors for delayed neurocognitive recovery. |
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