摘要
目的观察硝普钠控制性降压对老年病人鼻内镜手术后认知功能的影响。方法选择鼻内镜择期手术病人60例,年龄60岁以上,体质量40～75kg。随机分为非降压组(C组)和控制性降压组(D组)各30例。C组未控制性降压,D组于手术开始后泵入硝普钠1～5μg.kg-1.min-1,使平均动脉压(MAP)逐渐降到7.33～8.00kPa。于术前1d及术后2、6、24、48、72、96h采血测定血浆S-100β蛋白、神经元特异性烯醇化酶(NSE)含量,进行MMSE评分。结果与术前1d比较,两组术后2、6、24h的MMSE评分均明显降低(F=45.6、15.7,P<0.05);与C组比较,D组病人术后2、6、24h的MMSE评分降低更明显(t=2.2～3.4,P<0.05)。与术前1d比较,两组术后24、48h血浆S-100β蛋白水平明显升高(F=3.4、7.7,P<0.05),NSE含量未见显著增高;与C组比较,D组病人术后24、48h血浆S-100β蛋白水平升高更明显(t=2.3、1.8,P<0.05)。结论控制性降压加重老年病人术后早期认知功能障碍。
Objective To investigate the effect of controlled hypotension on cognitive function after endoscopic sinus sur gery in the elderly. Methods Sixty ASA Ⅰ or Ⅱ patients of over 60 years of age, and body weight 40 75 kg, scheduled for en doscopic sinus surgery were evenly randomized to nomcontrolled hypotension group （group C）, controlled hypotension group （group D）. In group C no hypotension was induced; in group D, continuous Ⅳ infusion of sodium nitroprusside at 1- 5 μg . kg-1 . min-1 was given, making mean arterial pressure （MAP） gradually decline to 7.33-8.00 kPa. The plasma S-100 βprotein and NSE were detected ld before surgery and 2, 6, 24, 72 and 96 h postoperatively, mini-mental state examination （MMSE） was used for scoring. Results Compared with before surgery, the MMSE scores in both groups （2,6, and 24 h after surgery） were markedly decreased （F = 45.6,15.7;P 〈0.05） ; compared with group C, the score of patients in group D of 2,6, and 24 h after sur gery was much more lower （t =2.2-3.4,P〈0.05）. S100 β levels were obviously higher at 24 and 48 h in both groups after surgery （F=3.4,7.7;P〈0.05）, but no increase of NSE was noted; the levels of S-100 βin group D were much higher than that in group C. Conclusion Controlled hypotension aggravate early postoperative cognitive dysfunction in the elderly.
出处
《齐鲁医学杂志》
2013年第5期414-416,共3页
Medical Journal of Qilu
关键词
降压
控制性
老年人
耳鼻喉外科手术
认知障碍
hypotension, controlled
aged
otorhinolaryngologic surgical procedures
cognition disorders
