脑氧饱和度监测下控制性降压对老年高血压患者术后谵妄的影响

Effects of controlled hypotension on postoperative delirium in elderly patients with hypertension under cerebral oxygen saturation monitoring

目的探讨脑氧饱和度(rSO 2)监测下控制性降压对老年高血压患者术后谵妄(POD)的影响。方法择期全麻下行鼻泪道手术的老年高血压患者110例,男53例,女57例,年龄65~85岁,ASAⅡ或Ⅲ级,高血压Ⅰ或Ⅱ级,采用随机数字表法分为两组:rSO 2监测组(S组)和对照组(C组),每组55例。两组均采用乌拉地尔联合艾司洛尔控制性降压,维持MAP≥基础值的70%,且MAP≥55 mmHg;当S组rSO 2<基础值的80%或rSO 2最低值<基础值的50%,并且持续时间大于10 s,则逐步提升血压直至rSO 2恢复至≥基础值的80%或绝对值>50%。C组rSO 2监护仪施行遮盖处理。记录入室后吸氧5 min(T 0)、控制性降压15 min(T 1)、30 min(T 2)、控制性降压结束后5 min(T 3)、拔管后10 min(T 4)的HR、MAP、rSO 2;记录rSO 2基础值、术中最低值及较基础值下降的最大百分比;术后1、2、3 d采用谵妄评定方法中文修订版(CAM-CR量表)对患者进行POD评估。结果与T 0时比较,T 1—T 2时两组MAP明显下降(P<0.05),C组rSO 2明显下降(P<0.05),T 3—T 4时逐渐回升至术前水平。T 1—T 2时S组rSO 2明显高于C组(P<0.05),术中rSO 2最低值明显高于C组(P<0.05),rSO 2较基础值下降的最大百分比明显低于C组(P<0.05)。术后1 d S组POD发生率明显低于C组(P<0.05)。结论rSO 2监测下控制性降压能减少老年高血压患者鼻泪道手术后谵妄的发生,提高围术期安全性。

Objective To explore the effect of controlled hypotension guided by cerebral oxygen saturation monitoring on postoperative delirium in elderly patients with hypertension.Methods A total of 110 patients with hypertension,grade of hypertensionⅠorⅡ,53 males and 57 females,aged 65-85 years,ASA physical statusⅡorⅢ,were scheduled for nasolacrimal duct surgery and randomly divided into two groups(n=55):group S and group C.Urapidil combined with esmolol was used for controlled hypotension in both groups,with maintaining MAP≥70%of the baseline and MAP≥55 mmHg.When the value of rSO 2 in group S was lower than 80%of the baseline or the lowest value of rSO 2 was less than 50%,and the duration was longer than 10 s,raising blood pressure gradually until rSO 2 restored to the required range(≥80%of baseline or absolute value>50%).The screen of rSO 2 monitor was covered in group C.HR,MAP and rSO 2 were recorded at 5 min oxygen inhalation after entering the room(T 0),15 min controlled hypotension(T 1),30 min controlled hypotension(T 2),5 min after controlled hypotension(T 3)and 10 min after extubation(T 4).The baseline of rSO 2,the lowest intraoperative value and the largest percentage of decline from baseline were recorded.Postoperative delirium(POD)was assessed with the Chinese revised confusion assessment method(CAM-CR scale)at postoperative 1,2,3 d.Results Compared with T 0,MAP in both groups significantly decreased at T 1-T 2(P<0.05),rSO 2 was significantly decreased in group C(P<0.05),rSO 2 in group S was significantly higher than that in group C at T 1-T 2(P<0.05).rSO 2 gradually returned to the preoperative level at T 3-T 4.The lowest value of rSO 2 in group S was higher than in group C(P<0.05),and the maximum percentage of rSO 2 decline was lower than that in group C(P<0.05).The incidence of POD in group S was lower than that in group C at postoperative 1 d(P<0.05).Conclusion Controlled hypotension guided by rSO 2 monitoring can reduce the incidence of POD in elderly patients with hypertension and improve perioperative safety.