老年心脏手术患者术后谵妄与脑氧明度降低的关系

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

术树突氢一般来说减低与神经系统肺炎相关。我们常用近红外光谱非侵入开放性地测量角化神经氢一般来说。本次研究观察了心脏动动手术中老年高血压围术期脑氢一般来说减低是否与术后神经系统肺炎相关。

在2015年至2017年期间，我们将70岁及以上计划进行心脏动手术的高血压纳入一项单中心、创新开放性、观察开放性研究。术前一天测量所有高血压脑氢一般来说基础值。在术中及ICU连续监测高血压脑氢一般来说至术后72h。常用ICU高血压意识模糊风险评估单（Confusion assessment method for the ICU，CAM-ICU）风险评估精神障碍，选用非解析分析和多变量Logistic回归分析赞赏其与精神障碍的相关开放性。

共计计103例高血压被纳入这项创新开放性观察开放性研究，去除不满足条件的高血压后再度共计96例高血压被纳入数据分析，其中29例（30%）高血压出现术后精神障碍。术树突氢一般来说减低与术后精神障碍无轻微相关开放性。与无精神障碍高血压相比，精神障碍高血压术后最低脑氢一般来说很低，且精神障碍高血压术后脑氢一般来说的绝对值相对下降来得轻微;排除脑氢一般来说原因后，高血压间其它差异不轻微。高龄、中风史、较高的EuroSCORE II打分、术前MMSE打分很低、术后较轻微的脑氢一般来说绝对值减低均与术后精神障碍的时有发生独立相关。

做体外循环心脏动手术的中老年高血压术后精神障碍与脑氢一般来说减低有关，相比之下在精神障碍发作后表现来得为轻微。

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.