The Effect Of Sleep Dysfunction On Postoperative Delirium In Patients With Laparotomy For Gastrointestinal Tumors

Objective:To investigate the effect of preoperative sleep dysfunction on postoperative delirium(POD)in elderly patients with laparotomy for gastrointestinal tumors.Methods: In this study,individuals aged 60 or older undergoing elective laparotomy for gastrointestinal tumors in our hospital were selected and classified as ASA I-II.Preoperative: The basic information of patients(such as gender,age,height,weight,etc.)and patients' preexisting medical status(mainly heart disease,hypertension,diabetes,etc.)was acquired from medical records of hospital system.Pittsburgh Sleep Quality Index(PSQI)was used to assess sleep dysfunction,Mini-mental State Examination(MMSE)was used to assess preoperative cognitive function,Visual Analogue Scale(VAS)was used to assess preoperative pain,Beck Anxiety Inventory(BAI)and Geriatric Depression Scale(GDS)were used to evaluated anxiety and depression respectively.According to the results of sleep assessment,patients were divided into non-preoperative sleep dysfunction group(N0 group)and preoperative sleep dysfunction group(N1 group).Intraoperative: Intravenous inhalation combined anesthesia,Bispectral index(BIS)was maintained between 40 and 60 during the operation.Postoperative: Confusion Assessment Method(CAM)was used to evaluate the occurrence of postoperative delirium(POD)and VAS was used to evaluate the pain of patients on the 1st and 3rd day after operation;MMSE was used to re-evaluate the cognitive function of patients on the7 th day after operation;the total hospitalization days and the hospitalization days after operation were recorded.Results:A total of 68 patients were enrolled in this study,aged between 60 and 73 years,with an average age of 65.2±3.7.In this study,23 cases(33.8%)were in the none-sleep dysfunction group(N0 group)and 45 cases(66.2%)were in the sleep dysfunction group(N1 group).(1)There were no significant differences in age,sex,body mass index(BMI),Surgical site,history of hypertension,diabetes,coronary heart disease and cerebrovascular disease,preoperative VAS score,preoperative MMSE score,BAI score,GDS score,anesthesia time and operation time between the two groups(P>0.05),Compared with the N0 group,the PSQI score of the N1 group was increased(P<0.05).(2)The incidence of POD was 26.1%(6/23)in N0 group,57.8%(26/45)in N1 group,and the incidence of POD was higher in N1 group(P=0.013<0.05).There was no significant difference in MMSE scores between the two groups on the 7th day after operation(P>0.05).The incidence of Postoperative cognitive dysfunction(POCD)in N0 group was8.7%(2/23),N1 group was 11.1%(5/45),and there was no significant difference between the two groups(P>0.05).There was no significant difference in VAS scores on the first day and the third day after operation between the two groups.There was no significant difference between the total hospitalization time and the post-operative hospitalization time between the two groups(P>0.05).(3)Overall,the MMSE score after operation was lower than that before operation(P = 0.005<0.05),and the MMSE score after operation in N1 group was lower than that before operation(P = 0.014<0.05),while there was no significant difference in N0 group(P>0.05).Conclusion:Compared with the patients without sleep dysfunction before operation,the incidence of POD in patients with sleep dysfunction before operation was higher,and the MMSE score after operation is lower than that before operation,but more relevant studies are needed to confirm it.