| Objectives To investigate the influence of sevoflurane combined anesthesia inhaled for different duration at a certain concentration on perioperative neurocogntive disorders in elderly patients.Methods 90 elderly patients aged from 65?80 who were classified ASA ??? and scheduled to have laparoscopic colorectal cancer surgeries were selected and randomly divided into three groups(n=30,each group):propofol group(Group P),half sevoflurane group(Group PS 1)and the whole sevoflurane group(Group PS2).Another 30 patients with colorectal cancer who were hospitalized during the same petiod were selected as the control group.After routine intravenous anesthetic induction,propofol continuous infusion was conducted in group P,propofol continuous infusion+inhalation of 1.OMAC sevoflurane during the first half of anesthesia and propofol continuous infusion during the second half were conducted in group PS1,and propofol continuous infusion+inhalation of 1.0MAC sevoflurane was conducted in group PS2.MAP and HR were recorded at 10 mintutes after entering the operating room(T0),10 mintutes after endotracheal intubation(T1),the beginning of surgery(T2),30 mintutes after establish pneumoperitoneum(T3),2 hours after anaesthesia(T4),the end of surgery(T5)and 2 hours after surgery(T6).All the patients were evaluated by MMSE at the day before operation(T7)and 6 hours(T8),1 day(T9),3 days(T10)and 7 days(T11)after operation.The control group was also tested at the same time interval.Levels of serum S100? protein,NSE,TNF-?,IL-6 and IL-1?were determined by EILSA at T7,T8,T9,T10 and T11.Recovery times,extubation times and recovery times of orientation were observed and recorded.The dosages of vasoactive drugs,remifentanil and cisatracurium were calculatedResults 1 There was no significant difference in general condition,surgery time and anesthesia time among the three groups(P>0.05).2 There was no significant difference in MAP and HR at other time points compared with T0 in all groups(P>0.05),expect that MAP decreased in group P at T1 and HR decreased in group P at T5,showing statistically significant difference(P<0.05).3 Compared with T7,MMSE scores were significantly lower(P<0.05)at T8 and T9 in all groups.Compared with T8 and T9 in group P,MMSE scores were significantly higher in group PS1 and PS2(P<0.05).The incidences of PND in group P at T8,T9,T10 and T11 respectively were 46.7%,30.0%,13.3%,3.33%,in group PS1 were 36.7%,20%,6.7%,0%,and in group PS2 were 30%,13.3%,6.7%,3.3%.4 S100? protein in all the groups were significantly higher at T8 and T9 compared with T7(P<0.01),and in group PS1 and PS2 were significantly lower at T8 and T9 compared with group P(P<0.05).NSE in all the groups were significantly higher at T9 compared with T7(P<0.01),and in group PS1 and PS2 were significantly lower at T8 and T9 compared with group P(P<0.05).TNF-? in all the groups were significantly higher at T8,T9,T10 and T11 compared with T7(P<0.01),in group PS1 were significantly lower at T8,T9 and T10 compared with group P(P<0.05),and in group PS2 were significantly lower at T8,T9,T10 and T11 compared with group P(P<0.05).IL-6 in group P and PS1 at T8,T9,T10 and T11 and in group PS2 at T8,T9 and T10 were significantly higher compared with T7(P<0.05),and in group PS 1 and PS2 were significantly lower at T8,T9,T10 and T11 compared with group P(P<0.05).IL-1? in all the groups were significantly higher at T8,T9 and T10 compared with T7(P<0.05),and in group PS1 and PS2 were significantly lower at T8,T9 and T10 compared with group P(P<0.05).5 The recovery times,extubation times and recovery times of orientation were shorter significantly(P<0.05)in group PS 1 and PS2 than group P,while there was no statistically significant difference between group PS1 and PS2(P>0.05).6 There was no significant difference in ivasoactive drugs,remifentanil and cisatracurium dosages among the three groups(P>0.05)Conclusions 1 Sevoflurane combined with propofol anesthesia and propofol anesthesia both can maintain the hemodynamic stability of the elderly patients during operation.2 Sevoflurane combined anesthesia has a less impact on cognitive function than propofol,and ostoperative anesthesia recovery is faster,while both can cause short-term postoperative cognitive decline in elderly patients.But there is no significant difference in the effects of duration of sevoflurane inhalation on cognitive function.3 Sevoflurane combined with propofol anesthesia may be better than propofol in inhibiting inflammatory response and thus reducing the effect on cognitive functionFigure 9;Table 8;Reference 136... |
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