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  

Effects of 3 Types of Antihypertensive Drugs on Cognitive Function in Elderly Hypertensive Patients after Acetabular Surgery

作　　者：张亮[1] 徐诣芝 敖丽[1] 刘艳艳[1] 曲世界 胡仁智[3] 汤伟[1] 傅洪[1] 

机构地区：[1]重庆市中医院麻醉科,重庆400021 [2]重庆市人民医院肿瘤血液科,重庆400014 [3]重庆市中医院检验科,重庆400021

出　　处：《中国药房》2017年第5期636-639,共4页China Pharmacy

基　　金：重庆市卫生计生委医学科研计划项目(No.20142073;2012-2-221)

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(P<0.05);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(P<0.05)。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(P<0.05);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(P<0.05);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(P<0.05)。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(P<0.05)。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。OBJECTIVE：To investigate the effects of 3 types of antihypertensive drugs on cognitive function in elderly hypertensive patients after acetabular surgery.METHODS：Ninety hypertensive patients receiving antihypertensive drugs for a long term（not changed antihypertensive drugs within 2 weeks before surgery） undergoing selective acetabular surgery were included sequentially and divided into angiotensin receptor blocker（ARB） group,angiotensin converting enzyme inhibitor（ACEI） group and calcium channel blocker（CCB） group according to the types of antihypertensive drugs,with 30 cases in each group.All patients received acetabular surgery under epidural anesthesia.The cognitive function of patients was evaluated by using MMSE 1 d before surgery（T0）,1 d after surgery（T2） and 3 d after surgery（T3）.The concentration of SlOOp protein serum was determined 1d before surgery（T0）,immediately after surgery（T1） and 1 d after surgery（T2）.RESULTS：Compared with T0,MMSE score of ARB group at T2,those of ACEI group and CCB group at T2 and T3 were decreased significantly,with statistical significance（P〈0.05）.Compared with ARB group,MMSE score of ACEI group and CCB group at T2,T3 were decreased significantly,with statistical significance（P〈0.05）.Compared with ACEI group,MMSE score of CCB group at T2,T3 were decreased significantly,with statistical significance（P〈0.05）.Compared with T0,the concentration of S100β protein in serum 3 groups were increased significantly,with statistical significance（P〈0.05）.Compared with ARB group,the concentration of SlOOp protein serum in ACEI group and CCB group were increased significantly,with statistical significance（P〈0.05）.Compared with ACEI group,the concentration of S100β protein serum in CCB group at T1,T2 were increased significantly,with statistical significance（P〈0.05）.The incidence of cognitive dysfunction was in ascending order of ARB group（30%）ACEI group（43%）CCB group（57%）.The incidence of cognitiv

关 键 词：高血压 降压药 认知功能障碍 

分 类 号：R972.4[医药卫生—药品] R614[医药卫生—药学]