脑氧饱和度监测对骨科高龄患者术后谵妄的预测价值  

Predictive value of cerebral oxygen saturation monitoring for postoperative delirium in elderly orthopedic patients

作　　者：李茜 昂扬 施敏 龙云 陈兴东 LI Qian;ANG Yang;SHI Min;LONG Yun;CHEN Xing-dong(Department of Anesthesiology,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,Jiangsu,China;Department of Anesthesiology,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,Jiangsu,China;Department of Anesthesiology,Nanjing 83rd Hospital,Nanjing 211131,Jiangsu,China)

机构地区：[1]南京医科大学附属江宁医院麻醉科,南京211100 [2]南京大学医学院附属金陵医院(东部战区总医院)麻醉科,南京210002 [3]南京八三医院麻醉科,南京211131

出　　处：《医学研究生学报》2022年第10期1059-1063,共5页Journal of Medical Postgraduates

基　　金：中华国际医学交流基金会中青年医学研究专项基金(Z-2018-35-1903)。

摘　　要：目的术后谵妄脑缺血、缺氧损伤相关。文中探讨脑氧饱和度(rScO_(2))监测在预测骨科高龄患者术后谵妄的应用价值。方法回顾性分析2020年4-12月在南京市江宁医院行骨科下肢手术的高龄患者154例,年龄70~85岁。患者均于术前行认知状态(MMSE量表)和抑郁状态(GDS量表)评估。手术均采用全身麻醉联合脑电双频指数(BIS)、无创脑氧饱和度(rScO_(2))监测,且术中均行动脉血气监测。以静息状态和吸氧状态下的脑氧和动脉平均压均值记为基线值rScO_(2)和MAP,并计算rScO_(2)曲线下面积(AUC-rScO_(2));以动脉血气值计算脑氧摄取(CMRO_(2)),并记录患者发生并发症以及恶心、呕吐等术后不良反应情况。采用logistic多元回归法分析谵妄相关危险因素。结果154例患者中发生谵妄25例,谵妄发生率16.23%。谵妄患者术中rScO_(2)最高值与基线值比较下降幅度均>30%。与非谵妄组比较,谵妄组患者rScO_(2)下降幅度差异有统计学意义(12.1%vs 6.1%,P<0.05),术前与手术结束即刻血气分析结果差值△Glu(5.12 mol/L vs 2.12 mol/L,P<0.05)、△CMRO_(2)(7.98%vs 4.02%,P<0.05)显著升高,差异有统计学意义。logistic多元回归统计结果提示,术后谵妄的危险因素包括高龄(OR=0.711,95%CI=0.029~1.443)、rScO_(2)变异度(OR=0.331,95%CI=0.051~1.941)、CMRO_(2)变异度(OR=0.407,95%CI=0.049~1.713)、糖尿病(OR=0.491,95%CI=0.027~1.740)。结论rScO_(2)术中监测可预测高龄骨科下肢手术患者术后谵妄的发生,提示调整术中脑灌注,对减少高龄骨科患者术后谵妄发生有指导意义。Objective To investigate the application value of cerebral oxygen saturation(rScO_(2))monitoring in predicting postoperative delirium in elderly orthopedic patients.Methods A total of 154 elderly patients,aged 70-85 years,who underwent orthopedic lower extremity surgery in Nanjing Jiangning Hospital from April to December 2020 were retrospectively analyzed.The cognitive status(MMSE)and depression status(GDS)were assessed in all patients before operation.All patients underwent general anesthesia combined with bispectral index(BIS)and non-invasive cerebral oxygen saturation(rScO_(2))monitoring,and intraoperative arterial blood gas monitoring.The mean values of cerebral oxygen and arterial mean pressure were recorded as baseline values rScO_(2)and MAP,and the area under the rScO_(2)curve(AUC rScO_(2))was calculated.Cerebral oxygen uptake(CMRO_(2))was calculated by arterial blood gas values,and complications,nausea,vomiting and other postoperative adverse reactions were recorded.Multiple logistic regression was used to analyze the risk factors of delirium.Results Delirium occurred in 25 of 154 patients,and the incidence of delirium was 16.23%.The maximum intraoperative rScO_(2)value decreased by more than 30%compared with the baseline value in delirium patients.Compared with the non-delirium group,the decrease of rScO_(2)in the delirium group was significantly different(12.1%vs 6.1%,P<0.05).The differences of△Glu(5.12 mol/L vs 2.12 mol/L,P<0.05)and△CMRO_(2)(7.98%vs 4.02%,P<0.05)were significantly increased between preoperative and postoperative blood gas analysis results.logistic multiple regression analysis showed that the risk factors of postoperative delirium included advanced age(OR=0.711,95%CI=0.029-1.443),rScO_(2)variation(OR=0.331,95%CI=0.051-1.941),CMRO_(2)variation(OR=0.407,95%CI=0.049-1.713)and diabetes mellitus(OR=0.491,95%CI=0.027-1.740).Conclusion Cerebral oxygen saturation(rScO_(2))intraoperative monitoring can predict the occurrence of postoperative delirium in elderly orthopedic lower extremity su

关 键 词：术后谵妄 高龄 骨科手术 脑氧饱和度 

分 类 号：R68[医药卫生—骨科学]