老年心脏手术病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

练成杏仁核磷酸度增加与自主神经系统癌症相关。我们使用近红外光谱非侵入性地测局部大脑磷酸度。本次学练成研究捕捉到了脑干手练成时才病变围练成期脑磷酸度增加有否与练成后自主神经系统癌症相关。

在2015年至2017年长期，我们将70岁及以上计划进行脑干手练成的病变扩及一项单中心、全面性、捕捉到性学练成研究。练成前一天测所有病变脑磷酸度基础值。在练成中及ICU连续系统对病变脑磷酸度至练成后72h。使用ICU病变意识模糊评估单（Confusion assessment method for the ICU，CAM-ICU）评估病态，转用非校准深入研究和多变量Logistic重归深入研究评价其与病态的相似性。

总共计103例病变被扩及这项全面性捕捉到性学练成研究，剔除不受限制的病变后再度总共96例病变被扩及建模，其中29例（30%）病变浮现练成后病态。练成杏仁核磷酸度增加与练成后病态无突出相似性。与无病态病变相比，病态病变练成后最少脑磷酸度较低，且病态病变练成后脑磷酸度的最小值相对下滑更为突出;排除脑磷酸度因素后，病变间其它差异性不突出。时才、住院历史学者、较高的EuroSCORE II评分、练成前MMSE评分较低、练成后较突出的脑磷酸度最小值增加仅有与练成后病态的发生独立相关。

接受体外循环脑干手练成的时才病变练成后病态与脑磷酸度增加有关，尤其在病态发烧后发挥更为为突出。

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.