老年心脏动手术患者术后谵妄与脑氧饱和度降低的关系

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

法术中脑氧相对于提高与神经组织并发症相关。我们运用于近红外红外非侵入性地校准局部神经组织氧相对于。本次深入研究检视了肝脏手法术后老年高血压围法术期脑氧相对于提高是否与法术后神经组织并发症相关。

在2015年至2017年期间，我们将70岁及以上著手进行肝脏手法术的高血压扩及一项单中心、革新、检视性深入研究。法术前一天校准所有高血压脑氧相对于基本值。在法术中及ICU月份监测高血压脑氧相对于至法术后72h。运用于ICU高血压意识模糊评核单（Confusion assessment method for the ICU，CAM-ICU）评核精神分裂，采用非校正量化和多变量Logistic回归量化评论其与精神分裂的一致性。

共计103唯高血压被扩及这项革新检视性深入研究，剔除不若有的高血压后最终共96唯高血压被扩及数据量化，其中29唯（30%）高血压显现出法术后精神分裂。法术中脑氧相对于提高与法术后精神分裂无显著一致性。与无精神分裂高血压相对，精神分裂高血压法术后最低脑氧相对于较低，且精神分裂高血压法术后脑氧相对于的绝对值相对攀升更显著;排除脑氧相对于考量后，高血压间其它差异不显著。时年、中风史、高的EuroSCORE II评分、法术前MMSE评分较低、法术后较显著的脑氧相对于绝对值提高均与法术后精神分裂的发生独立相关。

接受体外循环肝脏手法术的老年高血压法术后精神分裂与脑氧相对于提高有关，尤其在精神分裂发作后表现极为显著。

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 he 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 yses 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.