硝酸甘油控制性降压对异氟醚麻醉下鼻内镜术后老年病人认知功能的影响

Effect of nitroglycerin-induced hypotension on cognitive function after endoscopic sinus surgery under isoflurane anesthesia in eldedy patients

目的 评价硝酸甘油控制性降压对异氟醚麻醉下鼻内镜术后老年病人认知功能的影响.方法 择期拟行全麻下鼻内镜手术的慢性鼻窦炎病人40例,ASAⅠ或Ⅱ级,年龄65～85岁,体重40～75 kg,随机分为2组（n=20）：对照组（C组）和控制性降压组（H组）.H组术中静脉输注硝酸甘油2～5μg·kg^-1·min^-1进行控制性降压,MAP下降幅度维持在基础状态的30%左右,并维持MAP50 mm Hg,C组静脉输注等容量生理盐水.于术前1d（基础状态）、术后6、12、24、72h时记录简易智力状态检查表（MMSE）评分.结果 与基础值比较,两组病人术后6～24h时MMSE评分降低（P〈0.05）,术后72h时差异无统计学意义（P〉0.05）;与C组比较,H组病人术后6～24h时MMSE评分降低（P〈0.05）,术后72h时差异无统计学意义（P〉0.05）;H组术后认知功能障碍发生率（55%）高于C组（25%）（P〈0.05）.结论 硝酸甘油控制性降压可能加重异氟醚麻醉下鼻内镜术后老年病人一过性认知功能障碍.

Objective To evaluate the effect of nitroglycerin （NTG）-induced hypotension on cognitive function after endoscopic sinus surgery performed under isoflurane anesthesia in elderly patients.Methods Forty ASAⅠ or Ⅱ patients aged 65-85 yr weighing 40-75 ks undergoing endoscopic nasal sinus surgery for chronic sinusitis under isoflurane anesthesia were randomly divided into 2 groups（n=20 each）：control group（group C） and controlled hypotension group（group H）.Anesthesia was maintained with isoflurane inhalation in both groups.In group H controlled hypotension was induced and maintained with continuous iv infusion of NTG at function was assessed 1 day before（baseline）and at 6,12,24 and 72h after surgery using Minimental State examination （MMSE） and scored.Results The MMSE scores were significantly decreased after surgery from 6h to 24h in both groups and were significantly lower in group H than in group C.There was no significant difference in MMSE scores between the 2 groups at 72h after surgery.The incidence of cognitive deficit was significantly higher in group H（55%） than in group C（25%）.Conclusion Controlled hypotension induced by NTG may aggravate transient cognitive deficit after isoflurane anesthesia in elderly patients.