3类常用降压药对老年高血压患者髋关节术后认知功能的影响

发布时间：2019-02-12 07:48

【摘要】：目的:考察3类常用降压药对老年高血压患者髋关节术后认知功能的影响。方法:序贯性纳入合并高血压且长期服用降压药治疗(术前2周内未更换降压药)、择期行骨科髋关节术的患者90例,按服用降压药种类分为血管紧张素受体阻滞药(ARB)组、血管紧张素转化酶抑制剂(ACEI)组和钙通道阻滞药(CCB)组,各30例。所有患者均采用硬膜外麻醉进行骨科髋关节术。术前1 d(T_0)、术后1 d(T_2)、术后3d(T_3),采用简易智力量表(MMSE)评价患者认知功能。术前1 d(T_0)、术毕即刻(T_1)、术后1d(T_2)测定患者血清S100β蛋白的浓度。结果:与T_0时比较,ARB组患者T_2时、ACEI组和CCB组患者T_2、T_3时MMSE评分显著降低,差异有统计学意义(P0.05);T_2、T_3时,ACEI组和CCB组患者MMSE评分显著低于ARB组患者,CCB组患者MMSE评分显著低于ACEI组患者,差异有统计学意义(P0.05)。与T_0时比较,3组患者T_1、T_2时血清S100β蛋白浓度显著升高,差异有统计学意义(P0.05);与ARB组比较,ACEI组和CCB组患者T_1、T_2;时血清S100β蛋白浓度显著升高,差异有统计学意义(P0.05);与ACEI组患者比较,CCB组患者T_1、T_2;时血清S100β蛋白浓度显著升高,差异有统计学意义(P0.05)。3组患者认知功能障碍(POCD)发生率由低到高依次为ARB组(30%)、ACEI组(43%)、CCB组(57%),且CCB组患者POCD发生率显著高于ARB组,差异有统计学意义(P0.05)。结论:降压药可改善老年高血压患者髋关节术后认知功能,服用ARB类降压药的患者POCD发生率最低,效果优于ACEI类和CCB类降压药。
[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.
【作者单位】：重庆市中医院麻醉科;重庆市人民医院肿瘤血液科;重庆市中医院检验科;
【基金】：重庆市卫生计生委医学科研计划项目(No.20142073、2012-2-221)
【分类号】：R614

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