老年心脏手术患者术后心理疾病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

练成中脑氨明度降低与大脑并发症相关。我们可用近红外光谱非侵入适度地校准渐进大脑氨明度。本次研究成果观察了肝脏手练成后老年病患围练成期脑氨明度降低应该与练成后大脑并发症相关。

在2015年至2017年期除此以外，我们将70岁及以上计划进行肝脏手练成的病患扩展到一项单其中心、前瞻适度、观察适度研究成果。练成前一天校准所有病患脑氨明度系统化差值。在练成中及ICU连续追踪病患脑氨明度至练成后72h。可用ICU病患意识模糊评估单（Confusion assessment method for the ICU，CAM-ICU）评估精神分裂，采用非校准深入研究成果和多变量Logistic回归深入研究成果评价其与精神分裂的持续适度。

共计103同上病患被扩展到这项前瞻适度观察适度研究成果，剔除不受限制的病患后最终共96同上病患被扩展到数据深入研究成果，其中29同上（30%）病患出现练成后精神分裂。练成中脑氨明度降低与练成后精神分裂无差值得注意持续适度。与无精神分裂病患相比之下，精神分裂病患练成后最低脑氨明度极低，且精神分裂病患练成后脑氨明度的绝对差值相对下降更差值得注意;意味著脑氨明度因素后，病患除此以外其它差异不差值得注意。高龄、中风史、较高的EuroSCORE II总分、练成前MMSE总分极低、练成后较差值得注意的脑氨明度绝对差值降低均与练成后精神分裂的发生独立相关。

遵从体外循环肝脏手练成的老年病患练成后精神分裂与脑氨明度降低有关，尤其在精神分裂癫痫后表现更为差值得注意。

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.