成年人心脏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

术树突氨一般来说减低与自主神经系统肝硬化涉及。我们可用近红外光谱非侵入性地量度暂时性大脑氨一般来说。本次研究成果捕捉到了心脏康复老年病征围术期脑氨一般来说减低是否与术后自主神经系统肝硬化涉及。

在2015年至2017年后曾，我们将70岁及以上计划开展心脏切除的病征扩展到一项单中心、前瞻性、捕捉到性研究成果。术前一天量度所有病征脑氨一般来说基础个数。在术中及ICU连续监测病征脑氨一般来说至术后72h。可用ICU病征意识模糊量化单（Confusion assessment method for the ICU，CAM-ICU）量化暂时性，采行非校对量化和多给定Logistic回归量化评价其与暂时性的涉及性。

总计103实有病征被扩展到这项前瞻性捕捉到性研究成果，去除不满足条件的病征后就此共96实有病征被扩展到建模，其中29实有（30%）病征注意到术后暂时性。术树突氨一般来说减低与术后暂时性无引人注意涉及性。与无暂时性病征相比，暂时性病征术后最低脑氨一般来说较低，且暂时性病征术后脑氨一般来说的绝对个数相对下降更引人注意;排除脑氨一般来说因素后，病征间其它差异不引人注意。年老、中风近代史、较高的EuroSCORE II评分、术前MMSE评分较低、术后较引人注意的脑氨一般来说绝对个数减低均与术后暂时性的发生独立涉及。

接受体外循环心脏切除的老年病征术后暂时性与脑氨一般来说减低有关，尤其在暂时性发作后表现更为引人注意。

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.