| Objective:The purpose of this study was to investigate the effects of different anesthetic depths monitored by BIS on the level of serum S100? protein and postoperative cognitive function in patients undergoing cervical and thoracic laparoscopic combined with esophageal cancer resection.Methods:A total of 120 patients who underwent cervical and thoracic laparoscopic combined with esophageal cancer resection were divided into three groups by random number table method:light anesthesia group(group L,BIS value 45-60),deep anesthesia group(group D,BIS value 35-45),control group(group C,without BIS monitoring).Group D and group L maintained the BIS value in the preset range by adjusting the dosage of propofol,while group C maintained the fluctuation of MAP and HR within±20%by hemodynamics.All the patients in the three groups were treated with the same anesthetic drugs for total intravenous anesthesia.After anesthesia induction,double lumen endotracheal intubation,double lung auscultation and fiberoptic bronchoscopy were used to confirm the accuracy of alignment.The anesthesia machine was used for volume control ventilation.During the operation:SpO2?90%,PetCO2 was maintained at 35mmHg?45mmHg and peak airway pressure<30cmH2O.The general condition of the patients in the three groups and the vital signs of MAP,HR and SpO2 before induction(To),at the beginning of OLV(Ti),at the end of OLV(T2),10 minutes after extubation(T3)were recorded respectively.At the same time,the level of serum S100? protein was measured by enzyme-linked immunosorbent assay(ELISA)before induction(To),10 minutes after extubation(T3),the first day(T4)and the third day(T5)after surgery.Finally,the patients in the three groups were scored by the Mini-Mental State Examination Scale(MMSE)and the Monterey Cognitive Assessment Scale(MoCA)before operation and on the 1st,3rd and 7th day after operation,and the incidence of postoperative cognitive dysfunction(POCD)was calculatedResults:After the inclusion criteria and excluding the criteria screening,a total of 106 patients completed the cognitive scale test before operation and 1,3 and 7 days after operation.There was no significant difference in general condition,operation time,intraoperative fluid volume,fluid replacement volume and blood gas indexes among the three groups(p>0.05)1.Comparison of perioperative hemodynamics among three groups of patients:Compared with To,MAP and HR were all decreased in T1-3 of the three groups(P<0.05).Compared with group L,MAP and HR were significantly lower at T1-3 in group D and group C(P<0.05).Compared with To,the SpO2 was significantly higher of T1-3 in the three groups(P<0.05).There was no significant difference in SpO2 among the three groups at the same time(P>0.05)2.Comparison of MMSE and MoCA score scale among three groups of patients:there was no significant difference in the scores of MMSE and MOCA among the three groups on the 1st day before operation and the 7th day after operation(p>0.05).The scores of MMSE and MoCA in group L were significantly higher than those in the other two groups on the 1st day and 3rd day after operation(p<0.05)3.Comparison of the occurrence rate of POCD by MMSE rating scale among three groups of patients:The incidence of POCD in the three groups on the 1st day after operation was higher than that on the 3rd and 7th day after operation(P<0.05).The incidence of POCD on the 7th day after operation was 5.7%(2 cases)in group D,2.9%(1 cases)in group L and5.6%(2 cases)in group C.There was no significant difference in the incidence of POCD among the three groups(P>0.05).The incidence of POCD in group D was significantly higher than that in the other two groups on the 1st and 3rd day after operation(P<0.05)4.Comparison of the occurrence rate of POCD by MoCA rating scale among three groups of patients:The incidence of POCD in the three groups on the 1st day after operation was higher than that on the 3rd and 7th day after operation(P<0.05).On the 7th day after operation,there were 31.4%(11 cases)in group D,25%(9 cases)in group C and 14.3%(5 cases)in group L.The incidence of POCD in group C and L was significantly lower than that in group D(P<0.05)5.Comparison the level of S100? protein among three groups of patients:compared with that at To,the level of S100? protein was higher at T3-5 in the three groups(P<0.05).Compared with group D,the level of S100? protein was lower at T3-5 in group L and group C(P<0.05).Compared with group L,the level of S100? protein was higher at T3-5 in group C(P<0.05)Conclusion:1.For patients undergoing cervical and thoracic laparoscopic combined with esophageal cancer resection,BIS monitoring to maintain light anesthesia during operation can effectively reduce the incidence of POCD compared with traditional hemodynamic evaluation of anesthesia depth2.For patients undergoing cervical and thoracic laparoscopic combined with esophageal cancer resection,BIS monitoring to maintain light anesthesia during operation can reduce the incidence of POCD.The mechanism may be related to the reduction the level of S100? protein to improve brain injury. |
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