The Effect Of Transversus Abdominis Plane Block On Cognitive Function And Inflammatory Stress In Elderly Abdominal Surgery Patients

Objective:Before anesthesia induction,elderly patients undergoing abdominal surgery on a selected day shall be treated with transversus abdominis plane block.The effect of transversus abdominis plane block on inflammatory stress and postoperative cognitive function of elderly patients undergoing abdominal surgery shall be observed and further discussed,so as to provide further reference for reducing perioperative adverse stress and cognitive function damage of elderly patients undergoing abdominal surgery.Methods:Fifty elderly patients with ASA grade I-II,aged 65-75 years,who were scheduled to undergo abdominal surgery under general anesthesia,were divided into two groups according to random number table sampling method:transversus abdominis plane block combined with general anesthesia?group A,n=25?and general anesthesia?group G,n=25?.Two groups of patients were monitored for basic vital signs according to the routine after entering the room.Group A received transversus abdominis plane block under the costal margin 10min after entering the room according to the routine.Ropivacaine with a concentration of 0.25%was slowly injected into 25 ml on each side.Patients in both groups were given routine patient-controlled intravenous analgesia?PCIA?after operation.Visual analogue scale?VAS?was recorded at 12,24 and 48 hours after operation,and the number of pressing analgesic devices within 24 hours after operation was further recorded in both groups.5 minutes after entering the room?T₁?,5 minutes after induction of anesthesia?T₂?,cut skin immediately?T₃?,2h after skin incision?T₄?,immediately after surgery?T₅?,etc.5 different time points blood glucose?GLU?and C-reactive protein?CRP?concentrations.The concentration of neuron-specific enolase?NSE?in venous blood was measured at 5 time points including 1 day before operation?T_a?,5 minutes after entering the room?T_b?,immediately after operation?T_c?,1 day after operation?T_d?and 2 days after operation?T_e?.Two groups of patients were followed up 1day before operation?t₀?,1 day after operation?t₁?,3 days after operation?t₂?and 5 days after operation?t₃?.The basic assessment of cognitive function was carried out by Montreal cognitive assessment scale?MoCA?and Mini-mental State Examination?MMSE?.The occurrence of cognitive impairment after operation was recorded in both groups.Results:Compared with group A,VAS scores in group G increased significantly at 12 and 24 hours after operation?P<0.05?.Compared with T₁,GLU concentration in blood at T₃,T₄ and T₅ increased in both groups?P<0.05?.The concentration of GLU in group G was higher than that in group A at T₃,T₄ and T₅?P<0.05?.Compared with T₁,CRP concentration increased significantly at T₅ in both groups?P<0.05?.Compared with T_a,serum NSE levels in T_c,T_d and T_e groups were significantly increased?P<0.05?.Compared with group A,the concentration of NSE in group G increased significantly at T_c,T_d and T_e?P<0.05?.Compared with 1 day before operation,MoCA and MMSE scores of group G decreased significantly at 1 day and 3 days after operation?P<0.05?,while MoCA and MMSE scores of group A decreased at 1 day after operation?P<0.05?.Compared with group A,MoCA and MMSE scores in group G decreased significantly at 1 day and 3 days after operation?P<0.05?.Conclusion:Applying abdominal abdominis block to elderly patients undergoing abdominal surgery may reduce serum NSE levels and improve postoperative cognitive function and body stress response.