老年术后认知功能障碍与血压节律及胰岛素抵抗的相关性

目的探讨老年高血压患者24h动态血压节律及胰岛素抵抗对老年术后认知功能障碍的影响。方法对全麻下择期行非心脏手术且年龄≥60岁的老年患者测定术前24h动态血压。依据WHO／ISH高血压诊断标准将103例受试者按24h动态血压节律类型分为4组：杓型高血压组（25例）；杓型高血压加胰岛素抵抗组（26例）；非杓型高血压组（26例）；非杓型高血压加胰岛素抵抗组（26例）。术前及术后第7天用简易智能状态检查量表（MMSE）对所有受试者进行认知功能调查。结果非杓型高血压加胰岛素抵抗组MMSE得（24．3±1．3分），与杓型高血压加胰岛素抵抗组（27．3±1．7分）、杓型高血压组（28．3±0．6分）及非杓型高血压组（26．8士1．3分）比较，差异有显著性意义。结论血压昼夜节律减弱或消失合并胰岛素抵抗，与老年高血压患者的术后认知功能损害相关，且有协同作用。

Correlation of elderly post-operative cognitive dysfunction with blood pressure rhythm and insulin resistance

Objective To explore the effects of 24-hour dynamic blood pressure rhythm and insulin resistance metabolic disorder on postoperative cognitive dysfunction（POCD） in elderly hypertension patients. Methods Preoperative insulin resistance and 24-hour dynamic blood pressure in the elderly patients （age ≥60 years） undergoing non-cardiac surgery were determined. Following WHO/ISH criteria for diagnosis of hypertension, 103 subjects were divided into four groups according to 24-hour dynamic blood pressure rhythm： dipper hypertension group （25 cases）, dipper hypertension and insulin resistance metabolic disorder group （26 cases）, non-dipper hypertension group （26 cases）, and non-dipper hypertension and insulin resistance metabolic disorder group （26 cases）. All subjects were evaluated by Mini-Mental State Examination （MMSE） preoperatively and on day 7 postoperatively. Results The MMSE score was significantly lower in non-dipper hypertension and insulin resistance metabolic disorder group than in dipper hy-pertension and insulin resistance metabolic disorder group, dipper hypertension group and non-dipper hypertension group （24.3±1.3, 27.3±1.7,28.3±0.6,26.8±1.3, respectively, P〈0.05）. Conclusion A reduction and disappearance of blood pressure circadian rhythm complicated with insulin resistance is associated synergistically with the damage of postoperative cognitive function in elderly hypertension patients.