| Background: Along with the gradual aging of society and the continuous improvement of medical level,the number of operations of the elderly is on the rise,but the physical functions of the elderly gradually decline with the increase of age,and the elderly are often complicated with basic diseases,so their resistance to anesthesia and surgery is weak,and there is a high probability of postoperative complications.Postoperative cognitive dysfunction(POCD)was especially common.Its main characteristics are memory decline,performance loss,thinking disorders,etc.The duration can be as short as a few days or as long as several years,which not only lengthens the patient’s stay in hospital,but also affects daily life and increases the burden of family members and medical care.Currently,the recognized mechanisms mainly include inflammation,oxidative stress and cholinergic system disorders,among which inflammation has been considered to be an important factor in the occurrence of cognitive impairment.It has been found that butorphanol tartrate can inhibit the inflammatory response of myocardium induced by lipopolysaccharide(LPS)in vitro experiments,and it has also been shown in animal experiments that butorphanol can reduce the inflammatory response of neurons.Based on existing studies,the assumption of this study is that butorphanol tartrate could reduce inflammatory response and thus reduce the occurrence rate of postoperative cognitive impairment.According to the age characteristics of the population with cognitive impairment,we included elderly patients over 65 years of age,and collected peripheral blood samples to detect blood levels of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),and interleukin-10(IL-10).Objective: To investigate whether butorphanol can improve postoperative cognitive dysfunction and regulate blood inflammation in elderly patients.Methods: By sample size calculation,114 patients were contained in this research and randomly divided into two groups by statistical software,namely Butorphenol tartrate group(group B)and Sufentanil citrate group(group S).Patients were visited the day before surgery(D0)for consent and informed consent.Cognitive function was assessed using the Simple Neurological State Scale(MMSE)and the Montreal Scale(Mo CA).All subjects underwent surgery under static and aspiration combined anesthesia.The mean arterial pressure(MAP),heart rate,and BIS values were recorded intraoperatively at entry(T1),immediately after anesthesia induction(T2),5min after induction(T3),at the beginning of surgery(T4),and5 min after surgery(T5).The postoperative cognitive status of the patients was assessed by MMSE and Mo CA scales on day 1(D1)and day 3(D3).POCD was defined when the Zscole or composite Z-scole of the MMSE score and Mo CA score were both >1.96.In addition,enzyme-linked immunosorbent assay(ELISA)was used to measure the expression levels of IL-1β,TNF-α and IL-10 in the peripheral blood of patients on the day before surgery(C0),after leaving the PACU(C1),on the first day after surgery(C2)and on the third postoperative day(C3).Results:1.General demographic characteristics did not distinguish between the 2 groups(P>0.05).2.Clinical characters did not distinguish between groups(P>0.05).3.Intraoperative dosage of butorphanol tartrate and sufentanil citrate showed no statistical difference(P>0.05).4.At D0,there were no discrepancies in MMSE scores between the 2 groups(P>0.05).And in comparison to D0,MMSE scores in both D1 and D3 were reduced in both groups(P <0.05).The MMSE counts of group B were higher than those of group S at D1 and D3(P <0.05).At D0,Mo CA scores did not distinguish between the 2 groups(P>0.05).And in comparison to D0,Mo CA scores in both D1 and D3 were reduced in both groups(P <0.05).There was a difference in the Mo CA scores of D1 and D3 between the 2 groups(P <0.05).5.The occurrence rate of POCD in group B was lower than that in group S at D1 and D3(P<0.05).6.At time points C0,there were no discrepancies in the concentrations of TNF-α,IL-1β and IL-10 between 2 groups(P>0.05).Compared with C0 moment,the concentrations of TNF-αand IL-1β were increased at C1,C2 and C3 moment(P<0.05),while the concentration of IL-10 was decreased at 2 groups(P<0.05).At time points C1,C2,and C3,the concentrations of TNF-α and IL-1β in group B were lower than those in group S,respectively(P<0.05),while the concentration of IL-10 in group B was higher than that in group S(P<0.05).7.Compared with T1,the mean arterial pressure at T2,T3,T4 and T5 was declined in both groups.But it only makes sense at moments T2,T3,and T4(P<0.05).Compared with group S,the mean arterial pressure of group B at time T1-T5 was higher,but only at time T2,T3 and T4(P<0.05).Compared with T1 moment,heart rate at T2,T3,T4 and T5 in 2 groups decreased(P<0.05).At time T2,the heart rate of group B was greater than that of group S(P<0.05),but there was no discrepancy between groups at T1,T3,T4 and T5(P>0.05).8.Compared with T1 moment,BIS value at T2,T3,T4 and T5 in 2 groups was decreased(P<0.05).At T5,group B had a higher BIS value than group S(P<0.05),while there was no discrepancy in the BIS value between the two groups at the other moments.9.At time point D1,the incidence of PONV was less common in group B than in group S(P<0.05).The incidence of PONV did not differ between the 2 groups at time D3(P>0.05).Pain scores did not differ between groups(P>0.05).Conclusion:In this study,intraoperative administration of 40μg/kg butorphanol tartrate reduced the incidence of POCD on the first and third day after surgery in elderly patients,and the mechanism of action may be related to inhibiting inflammatory response. |
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