老年心脏手术后患者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

忍术延髓硫一般而言减小与神经系统败血症关的。我们常用近红外星体非侵入持续性地探测全局大脑硫一般而言。本次研究观察了心脏手忍术后后高龄病症围忍术期脑硫一般而言减小是否与忍术后神经系统败血症关的。

在2015年至2017年之前，我们将70岁及以上原先进行心脏手忍术后的病症纳入一项单区域内、前瞻持续性、观察持续性研究。忍术前一天探测所有病症脑硫一般而言基础值。在忍术中及ICU连续出现异常病症脑硫一般而言至忍术后72h。常用ICU病症意识模糊评估单（Confusion assessment method for the ICU，CAM-ICU）评估癫痫，换用非校正分析和多参数Logistic回归分析评论其与癫痫的关的持续性。

共计103亦然病症被纳入这项前瞻持续性观察持续性研究，列于不反之亦然的病症后最终共96亦然病症被纳入数据分析，其中29亦然（30%）病症出现忍术后癫痫。忍术延髓硫一般而言减小与忍术后癫痫无显著关的持续性。与无癫痫病症相比较，癫痫病症忍术后上限脑硫一般而言较低，且癫痫病症忍术后脑硫一般而言的绝对值相对下降更显著;剔除脑硫一般而言因素后，病症时有其它差异不显著。高龄、中风史、极低的EuroSCORE II评分、忍术前MMSE评分较低、忍术后较显著的脑硫一般而言绝对值减小以外与忍术后癫痫的发生独立关的。

给予体外循环心脏手忍术后的高龄病症忍术后癫痫与脑硫一般而言减小有关，尤其在癫痫中风后展现出较为显著。

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.