老年心脏手术患者术后谵妄与脑氧饱和度降低的关系

2020-06-04 anesthGH 罂粟花

术中脑氧饱和度降低与神经系统并发症相关。我们使用近红外光谱非侵入性地测量局部大脑氧饱和度。本次研究观察了心脏手术后老年患者围术期脑氧饱和度降低是否与术后神经系统并发症相关。

Association Between Postoperative Delirium and Postoperative Cerebral Oxygen Desaturation in Older Patients After Cardiac Surgery

背景与目的

术中脑氧饱和度降低与神经系统并发症相关。我们使用近红外光谱非侵入性地测量局部大脑氧饱和度。本次研究观察了心脏手术后老年患者围术期脑氧饱和度降低是否与术后神经系统并发症相关。

方  法

2015年至2017年期间,我们将70岁及以上计划进行心脏手术的患者纳入一项单中心、前瞻性、观察性研究。术前一天测量所有患者脑氧饱和度基础值。在术中及ICU连续监测患者脑氧饱和度至术后72h。使用ICU患者意识模糊评估单(Confusion assessment method for the ICU,CAM-ICU)评估谵妄,采用非校正分析和多变量Logistic回归分析评价其与谵妄的相关性。

结 果  

共计103例患者被纳入这项前瞻性观察性研究,剔除不满足条件的患者后最终共96例患者被纳入数据分析,其中29例(30%)患者出现术后谵妄。术中脑氧饱和度降低与术后谵妄无明显相关性。与无谵妄患者相比,谵妄患者术后最低脑氧饱和度较低,且谵妄患者术后脑氧饱和度的绝对值相对下降更明显;排除脑氧饱和度因素后,患者间其它差异不明显。高龄、中风史、较高的EuroSCORE II评分、术前MMSE评分较低、术后较明显的脑氧饱和度绝对值降低均与术后谵妄的发生独立相关。

 

 

 

结 论

接受体外循环心脏手术的老年患者术后谵妄与脑氧饱和度降低有关,尤其在谵妄发作后表现更为明显。

 

原始文献摘要

Eertmans W,De Deyne C,Genbrugge C,et al.Association Between Postoperative Delirium and Postoperative Cerebral Oxygen Desaturation in Older Patients After Cardiac Surgery. Br J Anaesth 2020; 124 (2): 146-153.

Background: Near-infrared spectroscopy non-invasively measures regional cerebral oxygen saturation. Intraoperative cerebral desaturations have been associated with worse neurological outcomes. We investigated whether perioperative cerebral desaturations are associated with postoperative delirium in older patients after cardiac surgery.
Methods: Patients aged 70 yr and older scheduled for on-pump cardiac surgery were included between 2015 and 2017 in a single-centre, prospective, observational study. Baseline cerebral oxygen saturation was measured 1 day before surgery.Throughout surgery and after ICU admission, cerebral oxygen saturation was monitored continuously up to 72 h after operation. The presence of delirium was assessed using the confusion assessment method for the ICU. Association with delirium was evaluated with unadjusted analyses and multivariable logistic regression.
Results: Ninety-six of 103 patients were included, and 29 (30%) became delirious. Intraoperative cerebral oxygen saturation was not significantly associated with postoperative delirium. The lowest postoperative cerebral oxygen saturation was lower in patients who became delirious (P¼0.001). The absolute and relative postoperative cerebral oxygen saturation decreases were more marked in patients with delirium (13 [6]% and 19 [9]%, respectively) compared with patients without delirium (9 [4]% and 14 [5]%; P¼0.002 and P¼0.001, respectively). These differences in cerebral oxygen saturation were no longer present after excluding cerebral oxygen saturation values after patients became delirious. Older age,previous stroke, higher EuroSCORE II, lower preoperative Mini-Mental Status Examination, and more substantial absolute postoperative cerebral oxygen saturation decreases were independently associated with postoperative delirium incidence.
Conclusions: Postoperative delirium in older patients undergoing cardiac surgery is associated with absolute decreases in postoperative cerebral oxygen saturation. These differences appear most detectable after the onset of delirium.



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