| [Objective]:To investigate the effect of propofol combined with fentanyl for postoperative pain gastroscopy cognitive function in patients with short-term, as well as the safety of propofol combined with fentanyl anesthesia for painless gastroscopy in.[Method]:1, before gastroscopy painless surgery patients routine fasting eight hours, forbidden to drink four hours.2, postoperative cognitive dysfunction (post operative cognitive dysfunction, POCD) diagnostic criteria used Mini Mental State Examination (mini-mental state examination, MMSE) score:preoperative evaluation of patients with postoperative cognitive ability; to after preoperative^2 points determined as the difference between the cognitive dysfunction;3, after regaining consciousness grading criteria adopted alertness;4, The method of administration:with a multi-function monitor, oxygen masks, endotracheal intubation and emergency medicine. Sign gastrointestinal endoscopy and anesthesia informed consent, burglary left lying located examination bed after giving nasal cannula oxygen (5.0L/min), continuous monitoring of blood pressure, heart rate, oxygen saturation, intravenous access. Administered by the anesthesiologist. Patients with oxygen 4- 5L/min, SpO2 more than 97%, intravenous fentanyl 0.4ug/ kg, slow intravenous injection of 1% propofol 1.5mg/kg (40～60 mg/min) 5 min after, to be patients should not call it, eyelash reflex stop and start pushing drugs into the microscope. When the surgery the patient improved OAA/S score> 2 points, when limbs move or moan, endoscopy process additional propofol injection 0.2mg/ kg, as appropriate;5, the data collection: ① detailed parameters of the patient’s gender, age, height, weight and other records. ② ask personal history of the patient, whether the smoke and the presence of long-term history of drinking ③ anesthesia rating:excellent, were no physical activity; physical activity benign influence operations, surgery can be performed; poor, physically tamper with, surgery can not get on. ④ adverse reactions were observed. ⑤ questionnaire:patients in the surgery waiting room, using Mini-Mental State Examination score (MMSE) scale questionnaire, ensure the test is completed in 15min, the degree of conscious patients recover after four evaluated using the MMSE scale again after 30 minutes Patients with cognitive abilities. And to ensure that the test is completed in 15min;6, statistics and analysis was performed using SPSS 19.0 software package. Data are presented as mean ± standard deviation (± s), said each group were compared using chi-square test, P<0.05 was considered statistically significant.[Results]:1. survey 178 cases of gastroscopy patients, found 22 cases of cognitive dysfunction, including 4 males and 18 females, male POCD incidence of 5.12%, the incidence of POCD 22.78 percent female; through between the two groups, p=0.008<0.05 was considered statistically significant. Investigate 90 cases of painless colonoscopy patients, cognitive dysfunction in 14 cases,9 males and 5 females, male POCD incidence of 18.75%, the incidence of POCD women 11.9%, p=0.371> 0.05 the difference was not statistically significant.2. gastroscopy in different age groups p= 0.091> 0.05 the difference was not statistically significant. Painless colonoscopy in different age groups p=0.560> 0.05 the difference was not statistically significant.3. gastroscopy in education levels among relatively p=0.309> 0.05 the difference was not statistically significant. Painless colonoscopy between each education level group p=0.537> 0.05 the difference was not statistically significant.4. gastroscopy POCD occurred in patients with normal BMI have nine cases, BMI is not normal 13 cases, BMI normal POCD incidence of 11.68%, BMI is not normal POCD incidence of 11.88%; by the comparison between groups, p=0.812> 0.05 difference was not statistical significance. Painless colonoscopy POCD occurred in the normal BMI have four cases, BMI is not normal 10 cases, BMI normal incidence of POCD 8.16%, BMI is not normal incidence of POCD 15.56%; between the two groups p=0.034<0.05 was considered statistically significant.5. Do not smoke gastroscopy in patients with POCD occurred occurred 10 cases,12 cases of smoking, do not smoke POCD incidence of 8.06% of patients, the incidence of smoking in patients with POCD 22.22%, by comparison between groups, p=0.008 <0.05 difference statistical significance. Do not smoke painless colonoscopy POCD occurred in patients 11 cases,3 cases of smoking, do not smoke POCD incidence of 15.28% of patients, the incidence of smoking in patients with POCD 16.67%, through the comparison between groups p=0.884> 0.05 the difference was not statistically significant.6. Do not drink gastroscopy POCD patients 12 cases,10 cases of drinking, drinking POCD incidence of 8.57% of patients, the incidence of POCD patients alcohol 26.31%, through the Inter-by group, p=0.003<0.05 difference was statistically significant. Do not drink painless colonoscopy patients POCD 11 cases,3 cases of drinking, drinking in patients with POCD incidence of 16.67%, alcohol 12.5% incidence of POCD patients, by comparison between groups, p=0.752> 0.05 the difference was not statistically significant.7. The survey 178 patients gastroscopy, found 22 cognitive dysfunction, through logistics analysis, the relationship between various factors and disturbance of consciousness. Found propofol combined with fentanyl, unconsciousness occurs in endoscopy positive correlation with gender, age, education, negatively correlated with body mass index. Investigate 90 cases of painless colonoscopy patients,14 cases disturbance of consciousness, through logistics analysis, the relationship between various factors and disturbance of consciousness. Smoking consciousness BMI was positively correlated with sex, age, and education and negatively correlated.[conclusion]:1. gastroscopy patients, propofol combined with fentanyl anesthesia women are more prone to POCD;2. painless colonoscopy, patients Propofol Fentanyl overweight are more prone to POCD;3. Impact Factors painless gastroscopy and colonoscopy POCD occurred slightly different. |
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