| Objective Perioperative neurocognitive disorders(PND)is a common neurological complication after surgery and anesthesia.The incidence of PND varies in different age groups,among which the elderly group has the highest in rate.PND involves various fields of cognition,including learning,memory,language,thinking,spirit,emotion,etc.Currently,PND is considered to be the result of interaction and joint action of multiple factors,while its pathogenesis is still unclear.However,it is believed that different anesthesia methods and anesthetics can affect the occurrence of PND.In terms of fact that it is difficult to comprehensively evaluate the impairment of cognitive function,our study focused on attention,which is the important components of cognitive function.Patients with cognitive dysfunction basically have different impairment of attention.The proposition of the theory of attention network model in which attention network was divided into alerting network,orienting network and executive control network,and invention of the Attention Network Test(ANT),which is based on this theory,enable us to test the efficiency of the Attention network which can reflect the function of the attention network.Each attention network has clear anatomical location and related neurotransmitter,making it very helpful using ANT to reveal the mechanism of PND.However,few studies have focused on the impairment of the attention network of middle-aged patients undergoing gynecological surgery.Therefore,ANT was used in this paper to explore the effects of anesthesia methods and anesthesia drugs on the attention network of middle-aged patients.Methods Part I: A total of 110 patients undergoing elective gynecological surgery in our hospital were randomly divided into epidural anesthesia group(group E,n=55)and total intravenous anesthesia group(group P,n=55).All patients were screened by mini-mental state examination 1d before surgery,and attention network test was performed 1d before surgery,1d after surgery and 5d after surgery.The efficiency of three attention networks were compared among the subjects.SPSS 13.0 software was used for statistical analysis.Part II: 83 patients undergoing elective gynecological surgery in our hospital were randomly divided into sevoflurane inhalation anesthesia group(group S,n=40)and propofol intravenous anesthesia group(group P,n=43).All patients were screened by mini-mental state examination 1d before surgery,and attention network test was performed 1d before surgery,1d after surgery and 5d after surgery.The efficiency of three attention networks were compared among the subjects.SPSS 23.0 software was used for statistical analysis.Part III: Eighty patients undergoing elective gynecological surgery in our hospital were randomly divided into placebo group(group P,n=40)and dexmedetomidine group(group D,n=40),Group D was given a loading dose of dexmedetomidine before anesthesia induction and maintained at 0.3?g/kg/h during operation.Group P was replaced by the same amount of normal saline.All patients were screened by mini-mental state examination 1d before surgery,and attention network test was performed 1d before surgery,1d after surgery and 5d after surgery.The efficiency of three attention networks were compared among the subjects.While conducting attention network test experiment,venous blood was collected and plasma interleukin-6(IL-6),tumor necrosis factor ?(TNF-?),S100 calcium binding protein ?(S100-?),norepinephrine(NE),acetylcholine(Ach)and dopamine(DA)concentrations were measured by ELISA.SPSS 23.0 software was used for statistical analysis.Results Part I: The alerting,orienting and executive control networks of patients in both groups were significantly impaired after surgery.Specifically,compared with preoperative day,the alerting network,orienting network and executive control network in group P were significantly damaged on the 1st postoperative day(vs preoperative day,P < 0.01),while the alerting network quickly recovered to the baseline level on the 5th postoperative day,and the orienting network recovered on the 5th postoperative day(vs 1st postoperative day,P < 0.01),but remained below the baseline level(vs preoperative day,P < 0.01).The performance of executive control network was similar to orienting network,with the recovery(vs 1st postoperative day,P < 0.01),but still below the baseline level(vs preoperative day,P < 0.01).The alerting network(vs preoperative day,P < 0.05),orienting network(vs preoperative day,P < 0.01)and executive control network(vs preoperative day,P < 0.01)in group E also showed significant impairment on the 1st postoperative day.The alerting network recovered to the baseline level on the 5th postoperative day(vs preoperative day,P > 0.05),as well as the orienting network.Similar to the group P,the executive control network recovered to certain extent(vs 1st postoperative day,P < 0.01)but still remained below the baseline level(vs preoperative day,P < 0.05).From another point of view,compared with group P,the impairment of alerting,orienting and executive control network was significantly less in group E on the 1st postoperative day(vs group P,P < 0.01).On the 5th postoperative day,the alerting network in both groups returned to the baseline level(vs preoperative day,P > 0.05),while the orienting network and executive control network recovered better than those in group P(vs group P,P < 0.05).Part II: The alerting,orienting and executive control networks in both groups were significantly impaired after surgery.Specifically,compared with preoperative day,the alerting network,orienting network and executive control network in group P were significantly impaired on the 1st postoperative day(vs preoperative day,P < 0.05).The alerting network quickly recovered to the baseline level on the 5th postoperative day(vs preoperative day,P > 0.05),while the orienting network recovered to certain extent on the 5th postoperative day(vs 1st postoperative day,P < 0.05),but still remained below the baseline level(vs preoperative day,P < 0.05), unfortunately,the executive control network showed no signs of recovery(vs preoperative day,P < 0.05;vs 1st postoperative day,P > 0.05).On the 1st postoperative day,the alerting network,orienting network and executive control network were significantly impaired in group S(vs preoperative day,P < 0.05),Similar to group P,the alerting network was restored to the baseline level on the 5th postoperative day(vs preoperative day,P > 0.05),while the executive network remained impaired(vs preoperative day,P < 0.05;vs 1st postoperative day,P > 0.05).The orienting network showed different recovery strategy with group P and recovered to the baseline level on the 5th postoperative day(vs preoperative day,P > 0.05).Laterally,the impairment of alerting and orienting network in group S was significantly less than that in group P on the 1st postoperative day(vs group P,P < 0.05),while the impairment of executive control network was more severe(vs group P,P < 0.05).On the 5th postoperative day,the alerting network in both groups recovered well(vs preoperative day,P > 0.05),while the orienting network in group S did not recover to the baseline level as in group P,but the degree of recovery was better(vs group P,P < 0.05),and the executive control network did not recover significantly(vs 1st postoperative day,P < 0.05).Part III: The alerting,orienting and executive control network of the two groups showed obvious impairment after operation.Specifically,patients in group P showed obvious impairment to the alerting network,orienting network and executive control network on the 1st postoperative day(vs preoperative day,P < 0.05).The alerting network recovered to the baseline level on the 5th postoperative day(vs preoperative day,P > 0.05),the orienting network recovered to certain extent(vs 1st postoperative day,P < 0.05)but still remained below the baseline level(vs preoperative day,P < 0.05),and the executive control network showed no signs of recovery(vs preoperative day,P < 0.05;vs 1st postoperative day,P > 0.05).In group D,the alerting network was significantly impaired on the 1st postoperative day(vs preoperative day,P < 0.05),while the orienting network was not significantly impaired(vs preoperative day,P > 0.05)and the executive control network has been improved(vs preoperative day,P < 0.05);In group D,the alerting network returned to the baseline level on the 5th postoperative day(vs preoperative day,P > 0.05)while the orienting network still remained intact(vs preoperative day,P > 0.05;vs 1st postoperative day,P > 0.05).The executive control network returned to the baseline level(vs preoperative day,P > 0.05;vs 1st postoperative day,P < 0.05).Horizontally,on the 1st postoperative day,the impairment degree of the alerting network in group D was less than that in group P,and the orienting network was completely protected,while the executive control network was improved.The detection of plasma biomarkers found that the level of IL-6?TNF-? and NE in group P all increased on the 1st postoperative day.On the contrary,the levels of Ach and DA decreased significantly(P < 0.05);As to group D,the levels of IL-6 and DA increased significantly(P < 0.05)while the level of NE decreased significantly(P < 0.05).Interestingly,the level of IL-6 increased less than that in group P(P < 0.05).On the 5th postoperative day,there was no significant difference in the levels of plasma biomarkers between the two groups(P>0.05).Conclusion 1.Different anesthesia methods will cause different degrees of attention network impairment after operation.Compared with epidural anesthesia,total intravenous anesthesia is more likely to impair the attention network and it is more difficult to recover.It is noteworthy that the executive control network is difficult to recover to the badeline level in a short-term observation despite the different method used for anesthesia.2.Different general anesthetics will cause different degrees of attention network impaired after operation.Propofol intravenous anesthesia will cause severer impairment to the patient's alerting network and orienting network,sevoflurane inhalation anesthesia will cause severer impairment to the patient's executive control network,and the executive control network is difficult to recover to the baseline level in a short-term observation using different anesthetics.3.Dexmedetomidine plays an important role in the protaction of attention network in middle-aged female patients undergoing gynecological surgery,with the help of recovery on the executive control network in a short time after operation,meanwhile,it significantly reduce the inflammatory reaction after surgical anesthesia. |
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