体外循环心脏手术中脑组织氧饱和度最低值与术后认知功能障碍相关性分析  

Association between cognitive dysfunction after cardiac surgery under cardiopulmonary bypass and the intraoperative lowest level of regional cerebral oxygen saturation

作　　者：常昕 郭震[2] 施丹[2] 徐花[2] 邹良建[1] ChangXin;Guo Zhen;Shi dan;Xu Hua;Zou Liangjian(Department of Cardiovascular Surgery,Changhai Hospital, Naval Military Medical University, Shanghai 200030, China)

机构地区：[1]海军军医大学附属长海医院心血管外科,上海研究生200433 [2]上海交通大学附属胸科医院心外科,上海200030

出　　处：《中国体外循环杂志》2019年第1期26-31,40,共7页Chinese Journal of Extracorporeal Circulation

摘　　要：目的分析体外循环心脏手术中脑组织氧饱和度(rScO_2)最低值与术后认知功能障碍(POCD)的相关性,并观察POCD的相关危险因素。方法 109例心脏手术患者术中维持rScO_2在80%基础值且绝对值55%以上。观察术中的rScO_2最低值,并记录体外循环时间、主动脉阻断时间、术中血红蛋白最低值、术中悬浮红细胞输入量、术后机械通气时间、ICU停留时间、术后住院天数、是否接收肾脏替代治疗及重要并发症。于术前1天及术后第4天做认知功能评估两项测试,其中任何一项术前减术后之差≥4分定义为POCD。结果 88例患者完成了术后评估测试,其中25例(28.4%)发生POCD。术中的rScO_2最低值与POCD相关。受教育程度是影响术后认知功能评估完成的危险因素。结论术中rScO_2最低值与POCD相关,rScO_2的最佳范围仍需进一步研究以明确。Objective To investigate whether the lowest regional cerebral oxygen saturation(rScO2)value during cardiopulmo.nary bypass(CPB)was associated with postoperative cognitive dysfunction(POCD)and to evaluate the risk factors of POCD.Meth.ods The rScO2 levels of 109 patients undergoing elective cardiac valve surgery were maintained during operation,with the baseline value greater than 80%and the absolute value higher than 55%.The lowest value of rScO2 was recorded,together with the duration of CPB,aortic crossclamp time,the lowest hemoglobin value,red blood cell transfusion,postoperative mechanical ventilation time,post.operative ICU stay,postoperative hospital stay,CRRT treatment and major organ complications.Two tests of cognitive assessment were conducted the day before surgery and at the 4th day after the surgery.POCD was diagnosed if the decrease of cognitive score after the surgery was greater than 4 in any item of the two tests.Results In the 88 patients who finished the whole test schedule,25(28.4%)developed POCD.The lowest rScO2 value during surgery was associated with POCD.The ability to perform the tests was impacted by educational level.Conclusion During cardiac surgery,the lowest rScO2 value was associated with POCD.However,further research was needed to confirm the optimal rScO2 safety range to reduce the incidence of POCD.

关 键 词：体外循环 心脏手术 术后认知功能障碍 脑氧饱和度 认知功能评估 危险因素 

分 类 号：R654.2[医药卫生—外科学]