| Objectives To explore two different depth of anesthesia effect of application in the elderly undergoing elective abdominal surgery patients,observe its time,operation time,postoperative pain for patients with anesthesia,NTI index,mean arterial pressure?MAP?,heart rate?HR?,S-100 beta protein,early cognitive function,the influence of postoperative cognitive dysfunction?POCD?.To provide theoretical basis for selecting appropriate anesthesia depth for patients with abdominal surgery.Methods Select our hospital from February 2015 to August 2015 were 139 cases of elderly undergoing elective abdominal surgery patients as the research object,aged 6080years old,average age 69.7±2.1,the American society of anesthesiologists?ASA?class??,anesthesia for tracheal intubation general anesthesia,the surgery is expected for 24 h.Any nerve,mental illness for a long time,has a long history of calm,antidepressant drugs,cardiovascular,liver and kidney function damage diseases,poor study before the test according to the medical behavior,unable to communicate,inability to obtain valid data,unable to follow-up of patients with postoperative.All patients or immediate family members sign informed consent forms.According to the depth of anesthesia,it was divided into shallow anesthesia groups?Low,L group,69 cases?and Deep anesthesia group?Deep,D group,70 cases?.The two groups of patients induced anesthetic procedure,drug,dose consistent,induced anaesthesia:midazolam static injection?0.05 mg/kg?,propofol iv pump(3mg.Kg-1.h-1),the concentration increased by 0.5mg/kg,2min/time.Intraoperative anesthetic depth NTI corresponding standard?control in 4764 L group,D group in 2036?,fentanyl static note 23 ug/kg,the interaction between rocuronium static note 0.6 mg/kg,endotracheal intubation,anesthesia machine mechanical ventilation.Intraoperative anesthesia:propofol iv pump 15 mg.Kg-1.h-1,rifentanyl 0.050.2ug.Kg-1.Min-1.Both groups used the same anaesthetic analgesic method.Baseline data of the two groups were recorded:age,sex,hypertension,diabetes,anesthesia time,operation time.The visual simulation score?VAS?was used to evaluate the degree of pain of 24 h after operation.Record contrast induced?T0?before and after induction?T1?,after the completion of intubation?T2?,after the start of operation?T3?,intraoperative 1 h?T4?and 2 h?T5?,bi?T6?,after extubation?T7?NTI,MAP,HR data.The preoperative 1d?T0?,24h?T1?after surgery,and 3d?T2?after surgery were used to assess the cognitive function of patients by the simple mental state scale?MMSE?and the clock test?CDT?.The data of 2h?T1?,intraoperative?T2?,2h?T3?and 24h?T4?s-100?protein were recorded by comparison of the comparison.The data results were analyzed by repeated variance analysis,and the postoperative cognitive dysfunction was analyzed using the international POCD composite Z method.Results 1 Two groups of patients with baseline data?the proportion of men and women,average age,height,weight,operation categories,the average operation time,ASA sizing,anesthesia time?data contrast has no statistical significance?P>0.05?.2 NTI,MAP,HR,NTI:T1,T2,T3,T4,T5,T6,T7 has and T0 data comparison with group D L all had statistical significance?P<0.05?,the contrast between the data set of T1,T2,T3,T4 data differences statistically significant?P<0.05?,the rest of the time data has no statistical significance?P>0.05?;MAP:T1,T2 and T0 data were compared with group D and group D,and the data comparison was statistically significant?P<0.05?,but there was no statistically significant difference between the groups?P>0.05?.HR:T2 and T0 data were both higher than group L and group D,statistically significant?P<0.05?,no statistical significance?P>0.05?.3.The dosage of anesthetic drugs,intraoperative situation and postoperative VAS score:the comparison of propofol D group and L group was larger,and the comparison of data was statistically significant?P<0.05?.Intraoperative and postoperative VAS score data were not statistically significant?P>0.05?.4 POCD occurrence:24 cases?34.78%?in L group,10 in D group?14.29%?,and statistically significant difference?P<0.05?.5 MMSE score and CDT score:the data of MMSE score and CDT score in both groups were not statistically significant?P>0.05?.6 S-100 protein:T1,T2 and T3 compared with T0 group D and L groups was increased,the data contrast was statistically significant?P<0.05?,T4 L group and T0 data comparison,the difference was statistically significant?P<0.05?;Comparison of data between group D and group L:data of T2,T3 and T4L was higher than group D,and the difference was statistically significant?P<0.05?.7 Adverse situation:two groups of patients who were not severe postoperative adverse reactions,with one group D in intraoperative medication mild upper respiratory tract obstruction,15 minutes before and after the patients after head tilted.Conclusions 1 Different anesthesia depth had no significant effect on postoperative cognitive function of postoperative patients with postoperative abdominal surgery.2.Compared with shallow anesthesia,deep anesthesia can reduce the incidence of POCD,which is more conducive to the recovery of cognitive function of patients.3.Compared with shallow anesthesia,deep anesthesia can maintain hemodynamics and heart rate stability.4.Compared with superficial anesthesia,deep anesthesia can effectively reduce the level of s-100?protein in patients. |
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