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

妖术延髓硫含水降低与神经组织并发症系统特质。我们使用近红外发射光谱非侵入特质地测局部神经元硫含水。本次科学研究掩蔽了肾脏做外科手妖术老年症状围妖术期脑硫含水降低是否与妖术后神经组织并发症系统特质。

在2015年至2017年期外，我们将70岁及以上计划书同步进行肾脏外科手妖术的症状纳入一项单教育中心、前瞻特质、掩蔽特质科学研究。妖术前一天测所有症状脑硫含水系统化参数。在妖术中及ICU连续监测症状脑硫含水至妖术后72h。使用ICU症状意识模糊评估单（Confusion assessment method for the ICU，CAM-ICU）评估精神分裂，采用非校正比对和多变量Logistic回归比对评价其与精神分裂的系统特质特质。

共计103例症状被纳入这项前瞻特质掩蔽特质科学研究，剔除不满足条件的症状后最终共96例症状被纳入数据比对，其中29例（30%）症状出现妖术后精神分裂。妖术延髓硫含水降低与妖术后精神分裂无明显系统特质特质。与无精神分裂症状相比，精神分裂症状妖术后略低于脑硫含水更高，且精神分裂症状妖术后脑硫含水的绝对参数相对下降更明显;剔除脑硫含水因素后，症状外其它差异不明显。年过、复发简史、较高的EuroSCORE II评分、妖术前MMSE评分更高、妖术后较明显的脑硫含水绝对参数降低均与妖术后精神分裂的发生独立系统特质。

接受体外循环肾脏外科手妖术的老年症状妖术后精神分裂与脑硫含水降低有关，尤其在精神分裂发作后表现更为明显。

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.