Effects Of Different Anesthetic Methods On Brain Function In Elderly Patients With Abdominal Surgery

Objectives To investigate the effects of general anesthesia combined with epidural anesthesia and general anesthesia on S100?,NSE,Cor levels and short-term brain function in elderly hypertensive patients,providing a basis for the selection of anesthesia.Methods Sixty ASA?~?,aged 65~80,accepted abdominal tumor surgery hypertensive patients were recruited and randomly divided into general anesthesia combined with epidural blockade group(group GE,n=30)and general anesthesia group(group G,n=30).The patients were from the North China University of Science and Technology Affiliated hospital during November 2016 to October 2017.All patients received goaldirected fluid th-erapy that based on stroke volume variation(SVV),and the Flotrac/Vigileo system w-as used to obtain SVV.The MAP,HR and SVV were recorded at entering room(T1),intubation(T2),probe(T5),extubation(T7).At entering room(T1),60 min after the operation(T3),120 min after the operation(T4),the end of the operation(T7)blood samples were taken to determine S100?,NSE and Cor levels.Operation time,recovery time,extubation time,recovery time of orientation and Steward scores were calculated.Minimental state examination(MMSE)test were given to the patients on the day before operation,one day after operation,three days after operation and seven days after operation.The dosages of propofol and remifentanil were recorded.Results 1 There was no difference between the two groups about general information(P> 0.05).2 MAP:There was no significant difference in group GE(P>0.05).There was significant difference in group G(P<0.05).MAP in T2 was higher than T1,and the difference was significant(P<0.01),in T7 was higher than T1,with a significant difference(P<0.05).There was different between the groups(P<0.05).The group G was higher than the group GE at T2 and T7,and the difference was statistically significant(P<0.05).HR:There were significant differences in the group GE(P<0.05),of which T7 was higher than T1,the difference was significant(P<0.05),T2 was higher than T1,there was a significant difference(P<0.01).There was a significant difference in the group G(P<0.01),with T2,T5,and T7 being higher than those in T1(P<0.01).There was a significant difference between the groups(P<0.05).The group G was higher than the group GE at T2,T5,and T7,and the difference was significant(P<0.05).SVV:There was no significant difference between group GE,neither do group G(P>0.05).There was no significant difference between group GE and group G(P>0.05).3 S100?:In group GE,S100? in T3,T4,T6 were significantly higher than T1(P<0.01);there was a significant difference in group G(P<0.01).S100? in T3,T4,and T6 were significantly higher than T1(P<0.01).Between groups,group G was higher than group GE at T3,T4,and T6,and difference in T3 was significant(P<0.05).T4 and T6 were significantly different(P<0.01).NSE:There were significant differences in group GE(P<0.01).NSE in T3,T4,T6 time points were significantly higher than T1(P<0.01).Group G,NSE in T3,T4,and T6 were significantly higher than T1(P<0.01).Between groups,group G was higher than group GE at T3,T4,and T6,and T3 difference was statistically significant(P<0.05).T4 and T6 were significantly different(P<0.01).4 The recovery time,extubation time,and recovery time of orientation in group G were longer than those in group GE(P<0.01).The Steward score was lower in group G than that in group GE(P<0.05).5 MMSE scores: There was a significant difference in the group GE(P<0.01).The scores on the day after operation,3ds after operation,and 7ds after operation were all lower than the day before operation.Between groups,the score of group G was lower than that of group GE,the difference was statistically significant(P<0.05).There was significant differences in the incidence of POCD between the two groups at 1d after operation and 7ds after operation(P<0.05).There was no difference in the incidence of POCD between the two groups at 3ds after operation.6 Cor :The T3,T4 and T6 in group G were higher than those in group GE(P<0.01).7 There was no significant difference in operation time between the two groups(P>0.05).The dosages of propofol and remifentanil in group G were more than that in group GE(P<0.01).Conclusions Compared with those in general anesthesia,patients' serum S100?,NSE,Cor levels are lower,and have less effects on postoperative short-term brain function.The reason is that combined anesthesia may inhibit stress response more completely.