老年患者心脏手术后谵妄与术后脑供氧不足有关
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Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery
背景与目的
近红外光谱可无创测量局部脑氧饱和度。术中脑供氧不足与较差的神经预后相关。本研究旨在探讨老年患者心脏手术后谵妄是否与围手术期脑氧饱和度降低有关。
方 法
2015年至2017年期间，70岁及以上择期行体外循环心脏手术的患者被纳入本项单中心、前瞻性、观察研究。术前1天测量脑氧饱和度基础水平。手术期间及转入ICU后，连续监测脑氧饱和度至术后72h。使用混淆评估法评估ICU内的谵妄发生情况，并采用未校正分析和多变量逻辑回归评估与谵妄的相关性。
结 果
103名患者中有96例被纳入研究，29例(30%)出现谵妄。术中脑氧饱和度与术后谵妄无显著相关性。谵妄患者术后最低脑氧饱和度较低(P=0.001)。与非谵妄患者（9 [4]% 和14 [5]%；P=0.002 和P=0.001）相比，谵妄患者术后脑氧饱和度绝对和相对降低更明显(分别为13[6]%和19[9]%)。排除患者发生谵妄后的脑氧饱和度值，这些脑氧饱和度的差异不再存在。高龄、既往卒中史、EuroSCORE II较高、术前简易精神状态测试评分较低，以及术后脑氧饱和度较明显绝对降低与术后谵妄的发生率独立相关。
结 论
老年患者心脏手术后谵妄与术后脑氧饱和度绝对降低有关。这些差异在谵妄发作后表现得最为明显。
原始文献摘要
Eertmans W, De Deyne C, Genbrugge C, et al. Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery. [J]. Br J Anaesth. 2019 Dec 17. pii: S0007-0912(19)30802-5.
Background: Near-infrared spectroscopy non-invasively measures regional cerebral oxygen saturation. Intraoperative cerebral desaturations have 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 analyses and multivariable logistic regression.
Results: Ninety-six of 103 patients were included, and 29 (30%) became delirious. Intraoperative cerebral oxygen saturation was not signifificantly associated with postoperative delirium. The lowest postoperative cerebral oxygen saturation was lower in patients who became delirious (P=0.001). 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]%; P=0.002 and P=0.001, 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.
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贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：王贵龙