硝普钠控制性降压对老年高血压患者髋关节置换术后认知功能和脑氧代谢的影响被引量：10

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摘要目的观察硝普钠控制性降压对老年高血压患者髋关节置换术后认知功能和脑氧代谢的影响。方法择期行髋关节置换术的老年高血压患者60例,年龄65～82岁,ASAⅡ级,随机均分为N组和C组。N组手术开始后,泵注硝普钠行控制性降压,MAP下降幅度在30%左右,保证MAP不低于55mmHg,术毕停止降压。C组不行控制性降压。于术前1d、术后4d测定简易智力状态检查表(MMSE)评分。于麻醉诱导前(T0)、降压后30min(T1)(C组在相应时间点)和术后30min(T2)同步采集桡动脉和颈内静脉血行血气分析,计算动脉血氧含量(CaO2)、颈内静脉球部血氧含量(CjvO2)、动脉-颈内静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2)。结果两组共有13例术后4d发生术后认知功能障碍(POCD),其中N组7例(23.3%),C组6例(20.0%)。N组在降压后Da-jvO2和CERO2有一定程度的增加但仍在正常范围之内。两组患者各时点CaO2、CjvO2、Da-jvO2和CERO2组内、组间比较差异无统计学意义。结论硝普钠控制性降压在老年高血压患者髋关节置换术中应用并不增加POCD的发生率,脑氧代谢对POCD的影响有待进一步研究。

作者刘佩蓉刁枢孙海峰王国平黄青云

机构地区上海市第七人民医院麻醉科

出处《临床麻醉学杂志》 CAS CSCD 北大核心 2009年第6期500-501,共2页 Journal of Clinical Anesthesiology

关键词控制性降压老年术后认知功能脑氧代谢

分类号 R614 [医药卫生—麻醉学]

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1Kadoi Y,Saito S,Goto F,et al. Decrease in jugular venous oxygen saturation during normothermic cardiopulmonary bypass predicts short-term postoperative neurologie dysfunction in elderly patients. J Am Coll Cardiol,2001,38:1450 1455.
2Gungen C, Ertan T, Eker E, et al. Reliability and validity of standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population. Turk Psikiyatri Derg, 2002,13:273-281.
3曹建国,洪涛,闻大翔,皋源,万燕杰,刁枢,李立志,杭燕南,孙大金.老年患者术后精神和认知障碍的发病率及相关因素分析[J].上海医学,2005,28(11):939-941. 被引量：92
4Dodds C, Allison J. Postoperative cognitive deficit in the elderly surgical patient. Br J Anaesth, 1998,81 : 449-462.
5Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. Lancet, 1998,351:857-861.
6Jansen GF, van Praagh BH, Kedaria MB, et al. Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumor surgery. Anesth Analg, 1999,89..358-363.

二级参考文献11

1Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAMICU). JAMA, 2001,286: 2703-2710.
2Rasmussen LS. Defining postoperative cognitive dysfunction.Eur J Anaesthesiol, 1998,15: 761-764.
3Selnes OA, Goldsborough MA, Borowicz LM, et al. Neurobehavioural sequelae of cardiopulmonary bypass. Lancet,1999,353:1601-1609.
4Rolfson DB, McElhaney JE, Rockwood K, et al. Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery. Can J Cardiol, 1999,15:771-776.
5Byrick RJ, Kay JC, Mazer CD, et al. Dynamic characteristics of cerebral lipid microemboli: videomicroscopy studies in rats.Anesth Analg, 2003,97 : 1789-1794.
6Gallinat J, Moller H, Moser RL, et al. Postoperative delirium: risk factors, prophylaxis and treatment. Anaesthetist,1999,48: 507-518.
7Cohendy R, Brougere A, Cuvillon P. Anaesthesia in the older patient. Curr Opin Clin Nutr Metab Care, 2005,8:17-21.
8Roman GC. Brain hypoperfusion: a critical factor in vascular dementia. Neurol Res, 2004,26:454-458.
9Moller JM, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet, 1998,351:857-861.
10Muller SV, Krause N, Schmidt M, et al. Cognitive dysfunction after abdominal surgery in elderly patients. Z Gerontol Geriatr, 2004,37:475-485.