老年心脏切除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

术中脑氧稍低下降与神经系统中风具体。我们使用远红外线光度非针对性地测量局部脑部氧稍低。本次科学研究辨别了心脏手术后中年患儿围术期脑氧稍低下降应该与术后神经系统中风具体。

在2015年至2017年期间，我们将70岁及以上蓝图进行心脏手术的患儿归属于一项单中心、革新、辨别性科学研究。术前一天测量所有患儿脑氧稍低基础差值。在术中及ICU年中监测患儿脑氧稍低至术后72h。使用ICU患儿意识模糊统计分析报告单（Confusion assessment method for the ICU，CAM-ICU）统计分析报告精神障碍，转用非校正统计分析和多变量Logistic回归统计分析评价其与精神障碍的具体性。

共计103例患儿被归属于这项革新辨别性科学研究，去掉不满足条件的患儿后最终共96例患儿被归属于数据统计分析，其中29例（30%）患儿显现出术后精神障碍。术中脑氧稍低下降与术后精神障碍无显著具体性。与无精神障碍患儿相较，精神障碍患儿术后最低脑氧稍低很高，且精神障碍患儿术后脑氧稍低的绝对差值相较下降更显著;排除脑氧稍低因素后，患儿间其它相似之处不显著。高龄、中风日本史、很高的EuroSCORE II评分、术前MMSE评分很高、术后较显著的脑氧稍低绝对差值下降均与术后精神障碍的发生分立具体。

接受体外循环心脏手术的中年患儿术后精神障碍与脑氧稍低下降有关，尤其在精神障碍发烧后表现更加显著。

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.