The Study On Influencing Factors Of Cognitive Impairment After General Anesthesia

Objectives:To study the influencing factors of short-term and long-term postoperative cognitive impairment after laparoscopic cholecystectomy under general anesthesia.Methods:The patients undergoing laparoscopic cholecystectomy at the Department of Hepatobiliary Surgery at the Second Affiliated Hospital of Nanchang University from June 2017 to September 2017 were recruited as the general anesthesia group,and the patients with conservative treatment of cholecystolithiasis as the control group.The MOCA scale was scored 1 day before general anesthesia,3 days after general anesthesia,and 6 months after general anesthesia.The control group was scored at the same time.Collect the patients' data and risk factors of cognition impairment.Recorded the anesthetic time,anesthetic medication,intraoperative blood pressure changes,intraoperative blood loss,postoperatively whether the pain situation and so on.The differences in cognitive impairment between the two groups at 3 days and 6months were analyzed.The patients were divided into the short-term cognitive impairment group and the postoperative normal group according to the cognitive changes at 3 days after general anesthesia.According to the cognitive scores at 6months after general anesthesia,the patients were divided into long-term cognitive dysfunction group and normal group.To study the influencing factors of short-term and long-term postoperative cognitive impairment after laparoscopic cholecystectomy under general anesthesia.Results:(1)100 patients undergoing laparoscopic cholecystectomy according to enrollment criteria and exclusion criteria were followed up.After operation 3 day.4patients were lost.25 patients(26.04%)had cognitive impairment in 96 patients after3 days of general anesthesia.In the control group,40 patients were enrolled in the group and no loss of follow-up after 3 days.There were 2 cases(5%)of cognitiveimpairment.There was a statistically significant difference in the incidence of cognitive impairment between the two groups(P<0.05).There was no significant difference in age,years of education,and general risk factors(age,education,gender,etc.)between the two groups(P>0.05).(2)Based on whether cognitive dysfunction occurred 3 days after general anesthesia,the patients in general anesthesia were divided into postoperative cognitive dysfunction group(POCD)and normal group(NPOCD).POCD group included 25 cases(26.04%)and NPOCD group included 71 cases(73.96%).The univariate analysis showed the age(P <0.05),years of education(P<0.05),anesthesia duration(P<0.05),and postoperative analgesia(P<0.05)were related to the occurrence of POCD.Multivariate analysis showed that age,education,and anesthesia time were independent risk factors of short-term cognitive impairment after general anesthesia(P<0.05).(3)A total of 90 patients in the general anesthesia group completed the follow-up after 6 months,11 cases(12.22%)presented to cognitive dysfunction.36 patients in the control group completed follow-up after 6 months,3 cases(8.33%)presented to cognitive dysfunction.Statistical analysis showed that there was no statistical difference in the incidence of cognitive impairment in the two groups at 6 months after general anesthesia(P > 0.05).(4)The scores on the three days after general anesthesia were statistically different from those before one day of general anesthesia and six months after general anesthesia(P<0.05).There was no difference between the scores at the 6 months after general anesthesia and 1 day before general anesthesia(P>0.05).(5)Among the 25 patients with cognitive impairment 3 days after general anesthesia,23 cases were followed up after 6 months,6 cases of cognitive impairment(26.09%).Among the 71 patients with cognitive normal 3 days after general anesthesia,67 cases were followed up after 6 months,4 cases of cognitive impairment(5.97%).Statistical analysis showed that there was a significant difference in the incidence of cognitive impairment between the two groups at 6 months after general anesthesia(P<0.05).Conclusions:(1)General anesthesia can result in short-term cognitive impairment after operation,but the long-term cognitive function and general anesthesia are not related.(2)The factors related to the occurrence of short-term cognitive impairment after general anesthesia are advanced age,low level of education,long anesthesia time,and no postoperative analgesia.Age,low education and long anesthesia time are independent risk factors.(3)The patients with short-term cognitive impairment after general anesthesia have an increased risk of long-term cognitive impairment.