Impact of propofol combined with sevoflurane anesthesia on postoperative cognitive function and serum levels of S100β,neuron specific enolase,and excitatory amino acids in elderly patients
Objective To explore the best anesthetic compatibility method for elderly patients with gastrointestinal tumor surgery,in order to reduce the incidence of postoperative cognitive dysfunction in elderly patients.Methods The study selected 124 elderly patients undergoing gastrointestinal tumor sur-gery at the Second Affiliated Hospital of Jiaxing University from January 2022 to December 2023.Patients were randomly divided into four groups(n=31)using a random number table method:Propofol group(group A),Sevoflurane group(group B),and two different Propofol/Sevoflurane combination groups(group AB1 and group AB2).Group A received target-controlled infusion of Propofol with a plasma target concentration of 2-4 µg/ml.Group B received inhalation of Sevoflurane at 1.7％-2.2％.Group AB1 re-ceived target-controlled infusion of Propofol with a plasma target concentration of 1.2 μg/ml and inhalation of Sevoflurane at 0.7％-1.2％.Group AB2 received target-controlled infusion of Propofol with a plasma target concentration of 0.6 µg/ml and inhalation of Sevoflurane at 1.2％-1.7％.General information of the patients was compared.S100β,neuron specific enolase(NSE),and excitatory amino acids(EAA)levels were measured 1 day before and 7 days after surgery.Cognitive function was assessed using the mini mental state examination(MMSE)and the montreal cognitive assessment(MoCA)1 day before and 7 days after surgery.Results After applying the inclusion and exclusion criteria,119 patients were included in the study.There was no significant difference in baseline data between the two groups.At T0,there was no significant difference in S100β,NSE,and EAA levels among the four groups(P＞0.05).Compared with group AB1,the levels of S100β,NSE,and EAA at T1 were lower in group A,group B,and group AB2[(12.3±1.1)µg/mlvs.(15.7±1.9),(14.2±1.5),(13.5±1.2)μg/ml,t=-8.302,-5.727,-4.177,P＜0.05;(680.5±58.6)ng/Lvs.(812.5±78.5),(782.6±70.5),(738.5±71.5)ng/L,t=-7.300,-6.040,-3.402,P＜0.05;(22.5±2.0)µmol/L vs.(30.5±2.9),(28.5±2.5),(25.3±2.2)µmol/L,t=-12.329,-10.366,-5.048,P＜0.05],with statistically significant differences.At T0,there was no significant difference in MMSE and MoCA scores among the four groups(P＞0.05).The MMSE and MoCA scores at T1 were lower in group A,group B,and group AB2 than in group AB1(27.6±1.4 vs.26.3±1.4,26.6±1.2,26.9±0.8,t=4.150,3.426,3.361,P＜0.05;27.6±1.2 vs.25.4±1.2,25.9±1.3,26.4±1.2,t=7.139,5.137,3.688,P＜0.05),with statisti-cally significant differences.The incidence of POCD in group AB1 was lower than that in group A,group B,and group AB2[1 case(3.4％)vs.11 cases(36.7％),9 cases(30.0％),8 cases(26.7％),x2=8.097,5.619,4.252,P＜0.05],with statistically significant differences.Conclusion In this study,the plasma target concentration of propofol(1.2 µg/ml)combined with sevoflurane(0.7％-1.2％)can significantly reduce the incidence of POCD in elderly patients undergoing surgery for gastrointestinal tumors.
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