Objective To evaluate influence of general anesthesia on postoperative cognition function in the elderly patients by using different methods and choose a better anesthesia method for elderly patients. Methods Forty elderly patients undergoing selective abdominal surgery were selected and divided into two groups: anesthesia was maintained with general anesthesia combined with epidural anesthesia in observe group and with general anesthesia singlely in control group. Vital signs were observed and recorded during operation and blood pressure varied within the extent of 20% of basic level. Cognition function of each patient 24 hours before and 24,48 hours after operation was e-valuated by MMSE method. Results All the patients maintained steady vital signs and there was no significant differ-ence in MMSE scores between two groups at all the time points. There were 11 cases(55% ) who had acute cognitive dysfunction in observe group and 13 cases(65%) in control group 24h after operation(P>0.05) ,5 cases(25%) in observe group and 9 cases(45%) in control group 48h after surgery(P>0.05). Conclusion Compared with single general anesthesia, general anesthesia combined with epidural anesthesia uses less general anesthetics and has less negative effect on postoperative cognition funetion in the elderly patients,it maybe better in elderly patients undergoing non-cardiac operation.

Objective To evaluate early diagnosis by gastroscopy for the causes of gastroduodenal perforation after successful non-surgical treatment.Method Gastroduodenal perforation patients suspected of benign ulcer in origin on hospital admission undergoing successful non-surgical treatment were examined by gastroscopy within days after the closure.Results Among 284 patients undergoing gastroscopy,277 cases (97.5％) were diagnosed as gastroduodenal ulcer,3 cases (1.1％) as gastric carcinoma,1 case (0.4％) of duodenal diverticulum.There were not major complications developing after gastroscopy.Conclusion Early gastroscopy performed after closure by non-surgical treatment in gastroduodenal perforation patients is safe,helping make definite diagnosis for the cause of perforation.

Objective To research early pathological morphology and clinical significance of perforated duodenal ulcer (PDU) closed after non-surgical treatment. Methods Observed morphological changes of duodenal ulcer (DU) lesion with gastroscopy for 302 patients of PDU with non-surgical treatment in early period,when the perforation closed and measured up the clinical indicators during this hospitalization.Results There were 255 patients to be diagnosed with DU caused the perforation. These lesions were characteristic and shown the PDU closed at the bottom and the deep concave ulcers, except for 1 case which complicated by duodenal fistula. These ulcer types were diverse according to the time difference after treatment. No case of re-perforated ulcers or recurrence of peritonitis caused by gastroscopy. Conclusions Deep concave ulcer with A1 phase mainly is an early pathological manifestations of the DU after treated the PDU with non-surgical method characteristically. The wall of the closure of the serosal side is an original form closed perforated ulcer by non-surgical treatment. The risk of perforation associated with the following factors:( 1 )A single DU is located in the anterior wall region. (2)The shape of two kissing DU. (3)The diameter of DU ≥ 1.1 cm. In this case,early diagnosis by using endoscopy is a safe way.