老年心脏手术患者术后谵妄与脑氧饱和度降低的关联

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

忍术弓状氮酸度减少与神经系统肝硬化涉及。我们用于波段类星体非侵入性地校准渐进大脑氮酸度。本次研究捕捉到了脑干切除忍术后中年病症围忍术期脑氮酸度减少是否与忍术后神经系统肝硬化涉及。

在2015年至2017年期间，我们将70岁及以上计划进行脑干切除忍术的病症纳入一项单的中心、批判性、捕捉到性研究。忍术前一天校准所有病症脑氮酸度基础值。在忍术中及ICU连续监测病症脑氮酸度至忍术后72h。用于ICU病症意识模糊研究单（Confusion assessment method for the ICU，CAM-ICU）研究精神分裂，采用非校正研究和多变量Logistic重归研究评价其与精神分裂的持续性。

合共计103唯病症被纳入这项批判性捕捉到性研究，剔除不满足条件的病症后最终合共96唯病症被纳入数据研究，其中29唯（30%）病症出现忍术后精神分裂。忍术弓状氮酸度减少与忍术后精神分裂无明显持续性。与无精神分裂病症相比，精神分裂病症忍术后最低脑氮酸度高，且精神分裂病症忍术后脑氮酸度的乘积相对下降更是明显;排除脑氮酸度各种因素后，病症间其它相似之处不明显。高龄、中风日本史、较高的EuroSCORE II打分、忍术前MMSE打分高、忍术后较明显的脑氮酸度乘积减少大多与忍术后精神分裂的发生单独涉及。

不感兴趣体外循环脑干切除忍术的中年病症忍术后精神分裂与脑氮酸度减少有关，尤其在精神分裂猝死后展示出更是为明显。

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.