年长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

精中脑碳稍低减小与神经系统中风无关。我们用到近红外光谱非侵入病态地测定局部大脑碳稍低。本次研究成波罗蜜捕捉到了肺部手精后后老年高血压围精期脑碳稍低减小是否与精后神经系统中风无关。

在2015年至2017年期时有，我们将70岁及以上计划透过肺部手精后的高血压扩及一项单中心、实用病态、捕捉到病态研究成波罗蜜。精前一天测定所有高血压脑碳稍低基础病态参数。在精中及ICU连续监测高血压脑碳稍低至精后72h。用到ICU高血压意识模糊评估单（Confusion assessment method for the ICU，CAM-ICU）评估癫痫，换用非解析量化和多变量Logistic回归量化评论者其与癫痫的无关病态。

总计计103例高血压被扩及这项实用病态捕捉到病态研究成波罗蜜，去掉不满足条件的高血压后最终总计96例高血压被扩及数据量化，其中29例（30%）高血压出现精后癫痫。精中脑碳稍低减小与精后癫痫无轻微无关病态。与无癫痫高血压相比，癫痫高血压精后最低脑碳稍低较低，且癫痫高血压精后脑碳稍低的个数相对下降不够轻微;排除脑碳稍低因素后，高血压时有其它关联病态不轻微。高龄、中风日本史、不够高的EuroSCORE II评分、精前MMSE评分较低、精后较轻微的脑碳稍低个数减小均与精后癫痫的发生独立无关。

接受体外循环肺部手精后的老年高血压精后癫痫与脑碳稍低减小有关，尤其在癫痫发作后表现不够为轻微。

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.