【摘要】：目的:考察3類常用降壓藥對老年高血壓患者髖關(guān)節(jié)術(shù)后認(rèn)知功能的影響。方法:序貫性納入合并高血壓且長期服用降壓藥治療(術(shù)前2周內(nèi)未更換降壓藥)、擇期行骨科髖關(guān)節(jié)術(shù)的患者90例,按服用降壓藥種類分為血管緊張素受體阻滯藥(ARB)組、血管緊張素轉(zhuǎn)化酶抑制劑(ACEI)組和鈣通道阻滯藥(CCB)組,各30例。所有患者均采用硬膜外麻醉進(jìn)行骨科髖關(guān)節(jié)術(shù)。術(shù)前1 d(T_0)、術(shù)后1 d(T_2)、術(shù)后3d(T_3),采用簡易智力量表(MMSE)評價患者認(rèn)知功能。術(shù)前1 d(T_0)、術(shù)畢即刻(T_1)、術(shù)后1d(T_2)測定患者血清S100β蛋白的濃度。結(jié)果:與T_0時比較,ARB組患者T_2時、ACEI組和CCB組患者T_2、T_3時MMSE評分顯著降低,差異有統(tǒng)計學(xué)意義(P0.05);T_2、T_3時,ACEI組和CCB組患者M(jìn)MSE評分顯著低于ARB組患者,CCB組患者M(jìn)MSE評分顯著低于ACEI組患者,差異有統(tǒng)計學(xué)意義(P0.05)。與T_0時比較,3組患者T_1、T_2時血清S100β蛋白濃度顯著升高,差異有統(tǒng)計學(xué)意義(P0.05);與ARB組比較,ACEI組和CCB組患者T_1、T_2;時血清S100β蛋白濃度顯著升高,差異有統(tǒng)計學(xué)意義(P0.05);與ACEI組患者比較,CCB組患者T_1、T_2;時血清S100β蛋白濃度顯著升高,差異有統(tǒng)計學(xué)意義(P0.05)。3組患者認(rèn)知功能障礙(POCD)發(fā)生率由低到高依次為ARB組(30%)、ACEI組(43%)、CCB組(57%),且CCB組患者POCD發(fā)生率顯著高于ARB組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:降壓藥可改善老年高血壓患者髖關(guān)節(jié)術(shù)后認(rèn)知功能,服用ARB類降壓藥的患者POCD發(fā)生率最低,效果優(yōu)于ACEI類和CCB類降壓藥。
[Abstract]:Objective: to investigate the effect of three kinds of commonly used antihypertensive drugs on cognitive function after hip joint operation in elderly patients with hypertension. Methods: a total of 90 patients with hypertension and long-term antihypertensive therapy (no replacement of antihypertensive drugs) were randomly divided into two groups according to the type of antihypertensive drugs (ARB) group). Angiotensin converting enzyme inhibitor (ACEI) group and calcium channel blocker (CCB) group (30 cases each). All patients were treated with epidural anesthesia for hip joint surgery in orthopaedic department. The cognitive function of patients was evaluated by mini-intelligence scale (MMSE) 1 day before operation, 1 day after operation (T _ 2) and 3 days after operation (T _ S _ 3). The serum S100 尾 protein was measured 1 day before operation (T _ (1), immediately after operation (T _ (1) and 1 day after operation (T _ (2). Results: compared with T _ 0, the MMSE scores of ARB group and CCB group were significantly lower than those of T _ 2 / T _ 2 group (P0.05). The MMSE score of ACEI group and CCB group was significantly lower than that of ARB group, and the MMSE score of CCB group was significantly lower than that of ACEI group (P0.05). Compared with T0, the serum S100 尾 protein concentration in the three groups was significantly higher than that in the ARB group (P0.05), and that in the ACEI group and the CCB group was significantly higher than that in the CCB group (P0.05), while in the ACEI group and CCB group, the serum S100 尾 protein level was significantly higher than that in the CCB group. The serum S100 尾 protein level increased significantly (P0.05), and compared with the ACEI group, the patients in the CCB group were compared with the patients in the CCB group, and the patients in the CCB group were compared with the patients in the CCB group. The incidence of (POCD) of cognitive dysfunction in three groups from low to high was 30%), ACEI group (43%), CCB group, 57% ARB group). The incidence of POCD in CCB group was significantly higher than that in ARB group (P0.05). Conclusion: hypotensive drugs can improve the cognitive function after hip joint operation in elderly patients with hypertension. The incidence of POCD is the lowest in patients who take ARB antihypertensive drugs, and the effect is better than that of ACEI and CCB antihypertensive drugs.
【作者單位】： 重慶市中醫(yī)院麻醉科;重慶市人民醫(yī)院腫瘤血液科;重慶市中醫(yī)院檢驗科;
【基金】：重慶市衛(wèi)生計生委醫(yī)學(xué)科研計劃項目(No.20142073、2012-2-221)
【分類號】：R614

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