硝普钠控制性降压对老年全髋置换术后认知功能的影响

Effects of nitroprusside induced hypotension on cognitive function after total hip replacement in geriatric patients

Objestive To investigate the effects of nitroprusside induced hypotension on cognitive function after total hip replacement and the serum S-100 level in reflecting postoperative cognitive dysfunction (POCD). Methods Forty patients (age>65 yr) undergoing total hip replacement were assigned to two groups, randomly. In one group, the mean arterial pressure was decreased about 30% by sodium nitroprusside. In another group, the MAP was set constant as control. Serum values of S-100 were determined preoperatively and 0 2 h and 24 h postoperatively. Neuropsychological tests (Mini-Mental State Examination MMSE) for detecting POCD were performed preoperatively and the 4th day after the operation. A decline of more than 2 scores in MMSE results was regarded as POCD. Results According to our definition, 7 patients had POCD. There were no significant differences in MMSE test in two groups (P>0.05). Those patients had POCD showed higher serum concentrations of S-100 than those without POCD, especially at 0, 2 h postoperatively (P<0.05). Conclusion Nitroprusside induced hypotension would not impair cognitive function in old patients after total hip arthroplasty. S-100 appears to be suitable in the assessment or incidence of cognitive dysfunctions postoperatively.

Objestive To investigate the effects of nitroprusside induced hypotension on cognitive function after total hip replacement and the serum S-100 level in reflecting postoperative cognitive dysfunction （POCD）. Methods Forty patients （age 〉65 yr） undergoing total hip replacement were assigned to two groups, randomly, in one group, the mean arterial pressure was decreased about 30% by sodium nitroprusside. In another group, the MAP was set constant as control. Serum values of S-100 were determined preoperatively and 0 2 h and 24 h postoperatively. Neuropsychological tests （Mini-Mental State Examination MMSE） for detecting POCD were performed preoperatively and the 4^th day after the operation. A decline of more than 2 scores in MMSE results was regarded as POCD. Results According to our definition, 7 patients had POCD. There were no significant differeeces in MMSE test in two groups （P 〉0.05）. Those patients had POCD showed higher serum concentrations of S-100 than those without POCD, especially at 0.2 h postoperatively （P 〈0. 05）. Conclusion Nitroprusside induced hypotension would no/impair cognitive function in old patients after total hip arthroplasty. S-100 appears to be suitable in the assessment or incidence of cognitive dysfunctioas postoperatively.