老年心脏手术病患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

妖术弓状氢原色下降与神经系统并发症关的。我们使用分光光度非侵入普遍性地计算发散脑干氢原色。本次系统性检视了肾脏手妖术后老年病患者围妖术期脑氢原色下降否与妖术后神经系统并发症关的。

在2015年至2017年期间，我们将70岁及以上计划进行肾脏手妖术的病患者划入一项单中心、前瞻普遍性、检视普遍性系统性。妖术前一天计算所有病患者脑氢原色框架系数。在妖术中及ICU不间断监测病患者脑氢原色至妖术后72h。使用ICU病患者意识模糊评估单（Confusion assessment method for the ICU，CAM-ICU）评估病态，采用非校正系统性和多给定Logistic回归系统性称赞其与病态的关的普遍性。

总共计103同上病患者被划入这项前瞻普遍性检视普遍性系统性，剔除不满足条件的病患者后再度总共96同上病患者被划入数据系统性，其中29同上（30%）病患者出现妖术后病态。妖术弓状氢原色下降与妖术后病态无引人注意关的普遍性。与无病态病患者相比，病态病患者妖术后最低脑氢原色很低，且病态病患者妖术后脑氢原色的绝对系数比较下降更引人注意;考虑脑氢原色因素后，病患者间其它差异不引人注意。高龄、发烧文化史、高的EuroSCORE II评分、妖术前MMSE评分很低、妖术后较引人注意的脑氢原色绝对系数下降均与妖术后病态的暴发独立国家关的。

给予体外循环肾脏手妖术的老年病患者妖术后病态与脑氢原色下降有关，尤其在病态发烧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.