A Randomized Controlled Study Of RScO₂ Combined With BIS In Reducing Postoperative Delirium In Elderly Patients With Esophageal Cancer

[Background and Objective]Postoperative delirium is an acute state of postoperative disorder,its incidence is high,and the quality of life of patients is greatly reduced.Postoperative delirium not only increases postoperative complications and mortality,but may be also associated with postoperative cognitive dysfunction,and significantly prolong the length of hospital stay and increase the cost of hospitalization.The cause of the disease is related to the nervous system injury of the patients before operation and the nervous system injury caused by surgery or anesthesia,such as age?>70 years?,nervous system diseases,prolonged surgery,inflammation,neurotransmitter disorders.These factors can directly or indirectly lead to cerebral hypoperfusion or metabolic abnormalities,resulting in postoperative delirium.Because of the above factors,the incidence of postoperative delirium is very high,and there is no better preventive measures.A number of studies have shown that postoperative delirium may be associated with cerebral ischemia and hypoxia injury,and local cerebral oxygen saturation can better reflect the oxygen supply and demand situation,so perioperative monitoring and controlling rScO2 in a reasonable range may help reduce cerebral ischemia and hypoxia damage and maintain normal brain metabolism,thereby reducing postoperative delirium.Objective:To explore the application value of cerebral oxygen saturation monitoring in elderly patients with esophageal cancer during anesthesia,and to provide a new method for reducing postoperative delirium in elderly patients with esophageal cancer.Therefore,this study assumes that:by monitoring and control of elderly??70 years?esophageal cancer patients with esophageal cancer radical surgery,intraoperative rScO₂absolute value of not less than 50%,decreased not less than preoperative pure oxygen rScO2 value(rScO_2?Ox?),the incidence of delirium in the rScO₂-guided group was significantly lower than that in the SaO₂-treated group.[Methods and Results]The final experiment included 282 patients who underwent radical surgery for esophageal cancer from October 2013 to October 2016.Patients older than 70 years old were randomly divided into experimental group?group A?and control group?group B?.Each of whom received general anesthesia and SLV using double-lumen endotracheal tube.These patients were randomly assigned to the test group or control group.In the test group,rScO₂ was measured using INVOS 5100BTM?Somanetics,Troy,MI,USA?before anesthesia and SLV was completed.We were based on BIS and rScO₂ to ensure that the absolute value of rScO₂ in the surgery is not less than 50%,the decrease is not less than80%of the rScO₂ value of pure oxygen(rScO_2?ox?).In the control group,We only record the rScO₂ value but not as an basis for anesthesia management.In both groups,the bispectral index?BIS?was observed and recorded at the corresponding time points.The diagnosis of delirium was assessed using CAM-ICU on one to seven days after surgery.We observed the incidence of delirium at 7 days postoperatively and conducted a comparative study.Results:1.The general condition?age,sex ratio,BMI,ASA grade?,hemodynamic at each time point were no statistics significance differences in the two groups of patients.2.There was no significant difference between the two groups in the time of operation,including the time of anesthesia,operation time,intraoperative infusion volume,intraoperative blood loss,intraoperative urine output,spontaneous respiratory recovery time and extubation time3.There was no significant difference between the two groups in the dose of propofol and remifentanil?P>0.05?.Also,There were no statistically significant differences in vasoactive drugs?including ephedrine and phenylephrine?between the two groups?P>0.05?.4.The total incidence of postoperative delirium in the experimental group was 14.6%lower than that in the control group?28.2%?,the incidence of delirium in the experimental group in the first day?11.7%?was significantly lower than that in the control group?21.4%?,and the incidence of the second day?2.2%?was lower than that of the control group?6.1%?,the statistical difference was statistically significant?P<0.05?.The duration of delirium in the trial group was significantly lower than that in the control group?P<0.05?.There was no statistic significant difference in pain,infection,cardiovascular and respiratory complications between the two groups.5.The hospital stay was significantly shorter in the test group than in the control group,and the difference was statistically significant?P<0.05?.[Conclusions]Combined with the results above,we can draw the conclusion as follows:1?rScO₂ and BIS co-guided anesthesia management can not only reduce the incidence of postoperative delirium in elderly patients with esophageal cancer,but also reduce the incidence of delirium at different times after surgery,but also can reduce the duration of postoperative delirium.2?rScO₂ and BIS co-guided anesthesia management can reduce the length of hospital stay,promote recovery,is conducive to the recent outcome of patients.