控制性降压对高血压病人术后认知功能的影响

EFFECTS OF CONTROLLED HYPOTENSION ON POSTOPERATIVE COGNITIVE FUNCTION IN HYPERTENSIVE PATIENTS

目的观察硝普钠控制性降压对高血压病人术后认知功能的影响。方法择期行鼻内镜手术病人40例,随机分为非降压组（C组）和降压组（D组）,各20例。C组未特意行控制性降压,D组于手术开始后泵入硝普钠1-5μg/（kg·min）,使平均动脉压（MAP）逐步达基础血压的70%,于术前1d,术后6、24、48、72h进行简明精神状态检查（MMSE）评分及蒙特利尔认知功能（MoCA）评分。结果与术前1d比较,C组和D组术后48、72h的MMSE评分明显升高,差异有显著性（F=6.1、6.4,P〈0.05）;C组和D组间MMSE评分比较差异无显著性（P〉0.05）。与术前1d比较,两组术后24、48、72h的MoCA评分明显升高,差异有显著性（F=16.0、10.6,P〈0.05）;与C组比较,D组术后24、48h的MoCA评分明显降低,差异有显著性（t=3.1、3.3,P〈0.05）。结论控制性降压不增加鼻内镜手术后非老年高血压病人短期认知功能障碍的发生。

Objective To investigate the effects of controlled hypotension with sodium nitroprusside on postoperative cognitive function in hypertensive patients. Methods Forty patients scheduled for nasal endoscopic surgery were evenly randomized to control group and controlled hypotension（CH）group.No controlled hypotension was given to patients in the control group.The blood pressure（BP）of patients in the CH group were controlled by pumping sodium nitroprusside at 1-5μg/（kg·min）to make the mean arterial pressure（MAP）reaching 70%of the basal BP.The cognitive function was assessed one day before surgery and at 6,24,48 and 72hafter surgery using minimented state examination（MMSE）and the Montreal Cognitive Assessment（MoCA）. Results Compared with the time at one day befone surgery,the MMSE scores in the control and CH groups-48 and 72hours after surgery-obviously elevated（F=6.1,6.4;P〈0.05）,but the difference of MMSE scores between the two groups were not significant.The MoCA scores significantly increased 24,48 and 72hafter surgery in the two groups compared with the time at one day befone surgery（F=16.0,10.6;P〈0.05）,and the MoCA scores in CH group-24 and 48hours after surgery-were lower than the control,the difference was significant（t=3.1,3.3;P〈0.05）. Conclusion Controlled hypotension for nasal endoscopic surgery does not increase postoperative incidence of short-term cognitive dysfunction in no-aged hypertensive patients.