Lidocaine On Postoperative Cognitive Function In Elderly Patients With Nasal Endoscopic Surgery

Objective: To observe the different time points of serum S-100? protein concentration change and MMSE score in different time points, preliminarily lidocaine on postoperative cognitive function in elderly patients with nasal endoscopic surgery effect and its possible mechanism.Methods: We selected 60 patients undergoing general anesthesia endotracheal intubation downward nasal endoscopic surgery elderly patients in the research. divided into lidocaine group(group?, n=30) and control group(group?,n=30), aged 65-80, ASA?-?level At Random.both choose the static absorption compound anesthesiathe lidocaine group before anesthesia induction from peripheral vein slowly,push note(not less than 2 min) load 2% lidocaine at 1. 0 mg/kg, continue at the l. 0 mg/kg/h speed of intravenous injection pump until finish operation. the control group are given such as capacity of physiological saline in the same conditions, two groups of the other medicine using the same.Respectively, before anesthesia induction and postoperative 6 h, 24 h, 48 h extract 3 ml, peripheral venous blood with ELISA detection of serum S-100? protein concentration. And respectively before anesthesia(d0), after 6 hours(d1) and postoperative 1(d2), 2(d3), 3 days(d4) to evaluate the cognitive function of patients and record the occurrence of POCD. record the operative field quality score, blood loss, etc., record breathing recovery time, response time, etc.,record preoperative injection pain,myoclonus,intraoperative know and chills, etc.another record hemodynamic changes during anesthesia and surgery.Results: the extubation(1) There are no statistical difference between the groups.(2) The change of hemodynamics:Two groups of patients with 15 min after surgery(T2), surgery after the start of the 30 min(T3) and before anesthesia induction(T0), 15 min after the extubation(T5) compared,systolic blood pressure(SBP), mean arterial pressure(MAP),diastolic blood pressure(DBP) is decreased obviously, heart rate(HR) faster significantly(P < 0.01).There was no significant difference compared between groups(P > 0.05).(3) The recovery of patients after surgery: there are no statistical significance(P > 0.05)between the two groups of patients with anesthesia time,extubation time and response time.(4) Compared with the differences, there have no statistical significance(P > 0.05) in operative field quality score, blood loss and transfusion volume.(5) Two groups of patients with intraoperative awareness and postoperative nausea and vomiting, etc, there have no statistical significance(P>0.05).the Lidocaine group of patients induced the incidence of injection pain, myoclonus, significantly lower than the control group, therefore there are statistically significant(P < 0.01)(6) The change of the concentration of serum S-100? protein:According to the two groups of patients before anesthesia induction of the concentration of serum S-100?protein, there are no statistical significance(P > 0.05). Lidocaine group 6 hours after the surgery and the control group 6, 24 hours after the surgery of serum S-100? protein concentration was significantly greater than the before anesthesia induction, so the differences between the two groups have statistically significant(P < 0.01). when Two groups of postoperative 24, 48 hours S-100? protein concentration measurements, and gradually reduced.In the compare-ison between the two groups, lidocaine group 6, 24 hours after the operation, serum S-100?protein concentration significantly lower than the control group, therefore the difference were statistically significant(P < 0.01).(7) The change of MMSE scores:Two groups of patients before anesthesia MMSE score comparison difference have no statistical significance(P > 0.05). the Lidocaine group after 6 hours, days and 1 control group after 6 hours after operation, postoperative days 1, 2, MMSE score are significantly lower than the basic value before anesthesia, the differences between the two groups are statistically significant(P < 0.05). Two groups of patients with postoperative days 1, 2, and 3 increased MMSE score, showing the process of the recovery. According to the comparison between groups, the lidocaine group 6 hours after operation, postoperative day 1 MMSE score were significantly higher than the control group, the differences between groups are statistically significant(P < 0.05).(8) The incidence of POCD:The lidocaine group 6 hours after operation, postoperative days 1, 2, the incidence of POCD was obviously lower than the control group, the difference were statistically significant(P < 0.01).Conclusion:Lidocaine can reduce the elderly patients with nasal endoscopic surgery of the incidence of POCD, and have a certain effect for the prevention and treatment of postoperative cognitive dysfunction.