老年心脏手术患者术后谵妄与脑氧饱和度减低的关系

Association Between Postoperative Delirium and Postoperative Cerebral Oxygen Desaturation in Older Patients After Cardiac Surgery

绝技枕叶硫含水增高与自主神经系统并发症就其。我们用作分光光谱非侵入病态地观测局部大脑硫含水。本次研究工作推论了肾脏复发老年病患围绝技期脑硫含水增高是否与绝技后自主神经系统并发症就其。

在2015年至2017年过后，我们将70岁及以上原先进行肾脏外科手绝技的病患归入一项单中心、前瞻病态、推论病态研究工作。绝技前一天观测所有病患脑硫含水基础性数值。在绝技中及ICU整年监测病患脑硫含水至绝技后72h。用作ICU病患意识模糊评核单（Confusion assessment method for the ICU，CAM-ICU）评核暂时性，采用非校正研究工作和多变量Logistic转回研究工作评价其与暂时性的就其病态。

共计计103可有病患被归入这项前瞻病态推论病态研究工作，剔除不满足条件的病患后终究共计96可有病患被归入数据研究工作，其中29可有（30%）病患出现绝技后暂时性。绝技枕叶硫含水增高与绝技后暂时性无明显就其病态。与无暂时性病患相比，暂时性病患绝技后略高于脑硫含水较少，且暂时性病患绝技后脑硫含水的绝对数值相对回升更明显;除去脑硫含水诱因后，病患间其它关联不明显。高龄、发作日本史、较少的EuroSCORE II评分、绝技前MMSE评分较少、绝技后较明显的脑硫含水绝对数值增高均与绝技后暂时性的再次发生独立就其。

接受体外循环肾脏外科手绝技的老年病患绝技后暂时性与脑硫含水增高有关，尤其在暂时性发作后表现更为明显。

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.