Effect Of Body Temperature Protection On Cerebral Oxygen Saturation And Postoperative Cognitive Function In Elderly Patients With Gastrointestinal Surgery

Objective:To explore the protective effect of heat preservation on brain tissue and the effect of POCD on postoperative patients with general anesthesia for gastrointestinal surgery.Method:Select ASA I-II level,age>sixty-five years old elderly patients with general anesthesia gastrointestinal surgery,screening sixty surgery cases which period is from two hrs to four hours as below.Random is divided into two groups:Group A(n=thirty)was body temperature protection group,used multiple ways to maintain the patient's normal body temperature.Group B(n = thirty)was the control group and no other warming treatment was performed.Select patients'tracheal intubation as visual laryngoscopy to assist,radial artery and deep vein intubation operation,heart rate and blood pressure of AB two patients groups were maintained within 30%of baseline fluctuations,maintain intraoperative pulse oxygen saturation(SpO2)more than 95%,Bispect Ral Index(BIS)interval 40-50 section,Central Venous Pressure(CVP)5-12cmH20.Observe and record patients of two groups after anesthesia induction(T0),the beginning of the surgery(T1),surgery 30mins(T2),surgery 1hr(T3),surgery 2hrs(T4),extubation(T5)nasopharynx temperature,thigh skin temperature inside,local cerebral oxygen saturation(SctO2)and arterial blood lactate(Lac)perhour.Adopt MMSE simple measure table to detect the cognitive dysfunction of patients at preoperative 24 hours and 48 hours and postoperative 24 hours and 48 hours respectively(the change of score>2 points was regarded as occurrence of POCD).Result:(1)Except T1(36.39±0.17 ?),group A has asignificant difference comparing with To(36.65±0.18?),and no significant difference in the rest of time sections,in every time points of group B has significant difference(P<0.05 with T0(36.63±0.36?)and there is no significant T0 difference between two groups;(2)After anesthesia induced lactic acid(Lac)(0.87±0.27 vs 0.97±0.23 mmol/L),there was no statistically significant within group and between two groups,both T4(1.30±0.22 vs 1.41±0.15 mmol/L)?T5(1.33±0.25 vs 1.50±0.19 mmol/L)in AB two groups have significant difference,in the meantime,Lac with groups Lac has difference(P<0.05);(3)SctO2 of two groups' patients were significantly lower than T0(73.42±3.83 vs 74.45±4.27)in T4(70.11±2.03 vs 70.01±2.16)and T5(69.23±2.00 vs 69.03±2.24)(P<0.05),but there was no significant difference between two groups(P>0.05),and the SctO2 of the two monitoring points were in the normal range;(4)T4,T5 lactic acid's increase has a certain correlation with SctO2's reduction;(5)The patients of two groups has different levels of postoperative cognitive dysfunction(POCD)at postoperative 24 hours(Casel2vs13)and 48 hours(Case8vs8)but there was no significant difference between two groups;(6)The occurrence of POCD has correlation with BMI(20.65±2.04)and age(72.60±7.23 years old).Conclusion:Intraoperative heat preservation is beneficial to keep the body temperature of the elderly patients with gastrointestinal surgery constant,but the local cerebral oxygen saturation and postoperative cognitive function had no significant effect.