心肺转流期间老年患者局部脑氧饱和度与术后认知功能障碍的相关性  

Relationship between regional cerebral oxygen saturation and postoperative cognitive dysfunction in elderly patients with cardiopulmonary bypass

作　　者：郑蒙蒙 邱丽丽[1] 邱晓东[1] ZHENG Mengmeng;QIU Lili;QIU Xiaodong(Department of Anesthesiology,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院麻醉科,南京市210009

出　　处：《临床麻醉学杂志》2022年第5期462-466,共5页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(81600950)。

摘　　要：目的探究老年患者心肺转流(CPB)期间局部脑氧饱和度(rSO_(2))与术后认知功能障碍(POCD)的相关性。方法选择择期行CPB下心脏手术的老年患者84例,男46例,女38例,年龄≥65岁,BMI 18~29 kg/m^(2),ASAⅡ—Ⅳ级。术中应用近红外光谱技术,持续监测rSO_(2)。采用神经心理学测试方法评估患者术前1 d和术后第7天的认知功能,采用Z值计分法判定POCD。根据术后第7天是否发生POCD将患者分为两组:非POCD组和POCD组。CPB前期包括入室吸氧前至主动脉插管(期间包括麻醉后、手术开始、劈胸骨、悬吊心包),CPB中期包括CPB开始至CPB结束(期间包括CPB低温恒温期及搭桥或换瓣),CPB后期包括主动脉拔管和术毕。记录CPB前期、中期、后期rSO_(2)平均值(rSO_(2mean)),术中rSO_(2)最低值(rSO_(2min))。采用Logistic回归和拟合曲线分析患者术中rSO_(2)与POCD的相关性。结果有36例(42.9%)患者发生POCD。多因素Logistic回归分析显示,CPB前期rSO_(2mean)(OR=1.12,95%CI 1.02~1.24,P=0.02)、CPB中期rSO_(2mean)(OR=1.55,95%CI 1.24~1.95,P<0.05)、CPB后期rSO_(2mean)(OR=1.32,95%CI 1.15~1.60,P<0.05)和rSO_(2min)(OR=1.33,95%CI 1.16~1.52,P<0.05)是发生POCD的独立危险因素。拟合曲线显示,CPB中期rSO_(2mean)(r=-0.60)和rSO_(2min)(r=-0.57)均与POCD呈线性负相关(P<0.05)。结论术中rSO_(2)降低与患者CPB术后发生POCD具有相关性。术中rSO_(2)降低可能是POCD的独立危险因素。Objective To examine the relationship between intraoperative regional oxygen saturation(rSO_(2))and postoperative cognitive dysfunction(POCD)in elderly patients with cardiopulmonary bypass(CPB).Methods Eighty-four elderly patients undergoing cardiac surgery under CPB,46 males and 38 females,aged≥65 years,BMI 18-29 kg/m^(2),ASA physical statusⅡtoⅣwere recruited.Near infrared spectroscopy was used to continuously monitor the intraoperative rSO_(2).All patients were tested using a cognitive function test the day before surgery and at the seventh postoperative day.The Z-value method was used to diagnose POCD.Patients were divided into two groups according to the occurrence of POCD on 7 days after the operation:non-POCD group and POCD group.Early CPB stage included before oxygen inhalation to aortic intubation(the period included post-anesthesia,the beginning of surgery,thorax splitting and pericardial suspension),and middle CPB stage included the beginning of CPB to the end of CPB(the period included CPB’s cryogenic and constant temperature stage and bypass or valve replacement).Late CPB stage included aortic extubation and the completion of surgery.rSO_(2mean) in early CPB stage,rSO_(2mean) in middle CPB stage and rSO_(2mean) in late CPB stage were recorded.rSO_(2min) represented the lowest intraoperative rSO_(2).The logistic regression and fitting curve were used to analyze the correlation between rSO_(2) and POCD.Results Thirty-six patients(42.9%)developed POCD after surgery.Multivariate Logistic regression analysis showed that rSO_(2mean) in early CPB stage(OR=1.12,95%CI 1.02-1.24,P=0.02),rSO_(2mean) in middle CPB stage(OR=1.55,95%CI 1.24-1.95,P<0.05),rSO_(2mean) in late CPB stage(OR=1.32,95%CI 1.15-1.60,P<0.05),rSO_(2min)(OR=1.33,95%CI 1.16-1.52,P<0.05)were independent risk factors for POCD.The results of fitting curve showed that rSO_(2mean) in middle CPB(r=-0.60)and rSO_(2min)(r=-0.57)were negatively correlated with POCD(P<0.05).Conclusion The decrease of intraoperative rSO_(2) was associated with POCD

关 键 词：术后认知功能障碍 心肺转流 局部脑氧饱和度 近红外光谱技术 

分 类 号：R614[医药卫生—麻醉学]