[Incidence of the post-operative cognitive dysfunction in elderly patients with general anesthesia combined with epidural anesthesia and patient-controlled epidural analgesia].
OBJECTIVE
To explore the effect of general anesthesia combined with epidural anesthesia and patient-controlled epidural analgesia on the incidence of the post-operative cognitive dysfunction (POCD) in elderly patients.


METHODS
A total of 100 elderly patients with gastric cancer, who underwent radical gastrectomy in Yan'an People's Hospital from March 2012 to March 2015, were randomly divided into 3 groups: a general anesthesia and patient-controlled intravenous analgesia (PCIA) (Group I, n=35), a general anesthesia combined with epidural anesthesia and PCIA (Group II, n=30), and a general anesthesia combined with epidural anesthesia and patient-controlled epidural analgesia (PCEA) (Group III, n=35). There was no significant difference in age, gender, body mass index (BMI), length of operation, American Society of Anesthesiologists (ASA) grade and Mini-Mental State Examination (MMSE) score (all P>0.05). The cognitive function was assessed at the 1st day before operation and at the 6 h, 12 h, 2 d and 6 d after operation by the Mini-Mental State Examination test (MMSE), and the incidence of POCD was compared among the 3 groups. The mean arterial pressure (MAP), blood glucose, cortisol and tumor necrosis factor α (TNF-α) content during the operation were considered. The dosage of sevoflurane (SEVO) in the operation process and the pain score at the 6, 12 and 24 h after operation were recorded.


RESULTS
The incidence of POCD at 6 h was 45.71% in the Group I and 34.28% in the Group II, which were higher than that in the Group III (10.00%). The incidence of POCD at 12 h was 34.29% in the Group I and 28.57% in the Group II, which were higher than that in the Group III (3.33%). The incidence of POCD at the 2 d was 28.57% in the Group I and 17.14% in the Group II, which were higher than that in the Group III (0). The incidence of POCD at 6 d was 17.14% in the Group I and 2.85% in the Group II, which were higher than that in the Group III (0). The blood glucose, cortisol and TNF-α content were consistent with the incidence of POCD, with significant difference (all P<0.05). The amplitude of MAP in the Group II and the Group III was significantly less than that in the Group I, and the postoperative analgesia effect in the Group III was obviously better than that in the other two groups (both P<0.05).


CONCLUSIONS
The general anesthesia combined with epidural anesthesia and patient-controlled epidural analgesia can effectively maintain the stable hemodynamic status in the patients and display inhibitory effect on postoperative cognitive dysfunction.
Department of Anesthesiology, Yan'an People's Hospital, Yan'an Shaanxi 716000, China wangyan09004@sina.com.
Yan
Y
Wang
Department of Anesthesiology, Yan'an People's Hospital, Yan'an Shaanxi 716000, China.
Xiaohua
X
Liu
Department of Anesthesiology, Yan'an People's Hospital, Yan'an Shaanxi 716000, China.
Haiying
H
Li
D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D003071:Cognition; D003072:Cognition Disorders; D060825:Cognitive Dysfunction; D005743:Gastrectomy; D006801:Humans; D015994:Incidence; D008738:Methyl Ethers; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D000077149:Sevoflurane; D013274:Stomach Neoplasms; D014409:Tumor Necrosis Factor-alpha
D008738:Methyl Ethers; D014409:Tumor Necrosis Factor-alpha; D000077149:Sevoflurane