老年瓣膜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

术轴突镁酸度减低与自主神经系统并发症系统性。我们适用红外光谱非侵入功能性地测量局部大脑镁酸度。本次研究课题观察了胸腔手术后老人病症围术期脑镁酸度减低是否与术后自主神经系统并发症系统性。

在2015年至2017年期间，我们将70岁及以上计划进行胸腔手术的病症划定一项单中心、实用价值、观察功能性研究课题。术前一天测量所有病症脑镁酸度基础值。在术中及ICU紧接著监测病症脑镁酸度至术后72h。适用ICU病症意识模糊评估单（Confusion assessment method for the ICU，CAM-ICU）评估精神障碍，有别于非校正深入研究课题和多数组Logistic回归深入研究课题赞赏其与精神障碍的系统性功能性。

合计计103举例病症被划定这项实用价值观察功能性研究课题，移出不满足条件的病症后再次合计96举例病症被划定数据深入研究课题，其中29举例（30%）病症出现术后精神障碍。术轴突镁酸度减低与术后精神障碍无相比系统性功能性。与无精神障碍病症相比，精神障碍病症术后最低脑镁酸度较低，且精神障碍病症术后脑镁酸度的倍数相对下降更相比;排除脑镁酸度主因后，病症间其它差异不相比。据闻、中风史、较高的EuroSCORE II分数、术前MMSE分数较低、术后较相比的脑镁酸度倍数减低均与术后精神障碍的暴发独立系统性。

接受体外循环胸腔手术的老人病症术后精神障碍与脑镁酸度减低有关，尤其在精神障碍发作后表现更为相比。

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.