| Objective:This study aimed to observe the effects of different degrees of gastrointestinal cancer-related anemia(CRA)on early postoperative cognitive function and the changes in inflammatory factors.Methods:Seventy elderly patients were selected for this study,all of whom were proposed to undergo elective laparoscopic gastrointestinal tract tumor surgery.Patients were enrolled in strict accordance with the established inclusion and exclusion criteria.According to the clinical practice guidelines for cancer-related anemia,the patients were assigned to three groups based on the preoperative hemoglobin(HGB): normal HGB group(HGB: male >120g/L,female > 110g/L,N group),cancer-related mild anemia group(HGB: 90 g/L ～normal,CMi group)and cancer-related moderate anemia group(HGB: 60-90g/L,CMo group).The cognitive function of the patients was evaluated with the Mini-Mental State Examination(MMSE)and the Montreal Cognitive Assessment(Mo CA)on the first day before surgery(D1),and then the patients have graded again on the third day(D3)and the seventh day(D7)after surgery.The whole process was carried out in a quiet environment.Timely observation and recording of bleeding volume,urine volume,and other data information during the surgery.Meanwhile,peripheral venous blood from patients the one day before surgery(T0),immediately after surgery(T1),24 hours after surgery(T2),and 3 days after surgery(T3)were collected and stored after treatment.The concentrations of tumor necrosis factor-α(TNF-α)and S100 calcium-binding proteinβ(S100β)in the serum of the patients were detected by Enzyme Lined-immuno-sorbent Assay(ELISA).Finally,a series of statistical analyses were conducted to conclude.Result:There were no significant differences in age,sex,body mass index,length of education,surgical site,and past medical history among the three groups(P > 0.05).Among the 65 patients,26.2% and 23.1% of patients developed postoperative cognitive dysfunction(POCD)on the 3rd and 7th day after surgery,respectively.The incidence of POCD on the 3rd and 7th day after surgery in Group CMo was 52.6%and 57.9%,which was higher than that in Group N and Group CMi(P<0.05).The aggravation of anemia was an independent risk factor for POCD on the 3rd and 7th day after surgery(P=0.043,P=0.004).In addition,serum concentrations of TNF-αand S100β in the POCD group were elevated postoperatively compared with those before surgery(P<0.05).The serum concentration of TNF-α and S100β at the T2 moment were significantly higher than those in the non-POCD group(P<0.05).The serum concentration of TNF-α and S100β were elevated postoperatively compared with those before surgery in Group CMo(P<0.05).Compared with Group N and CMi,the serum concentration of TNF-α and S100β in the Group CMo increased at the T2 moment,and the difference between them was statistically significant(P<0.05).Conclusion:Studies have found that in elderly patients undergoing surgery for gastrointestinal malignancies,patients with CRA are more likely to develop POCD in the early postoperative period than normal patients,and the incidence of early POCD in patients with moderate anemia is higher than that in patients with mild anemia,which is related to the aggravation of postoperative inflammatory reaction.The severity of anemia was an independent risk factor for early POCD. |
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