脑组织氧饱和度降低预测胸科术后早期认知功能减退的阈值探索  

Exploration of Cerebral Deoxygenation Threshold to Predict Early Postoperative Cognitive Decline in Thoracic Surgery

作　　者：王思洋 刘斌[2] Wang Siyang;Liu Bin(Department of Anesthesiology,Zhongshan Hospital,Fudan University,Shanghai 200032;Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032 [2]四川大学华西医院麻醉科,四川成都610041

出　　处：《四川医学》2023年第10期1035-1040,共6页Sichuan Medical Journal

摘　　要：目的探索单肺通气(OLV)期间脑组织氧饱和度(S_(c)O_(2))降低对胸外科术后早期认知功能减退的预测性和降低阈值。方法本研究为前瞻性队列研究。根据OLV期间S_(c)O_(2)相对基础值降低的百分比(S_(c)O_(2)变异度),将254例患者分为四组:变异度<10%(D1组)、10%≤变异度<15%(D2组)、15%≤变异度<20%(D3组)和变异度≥20%(D4组)。主要观察结果为术后早期认知功能减退。结果S_(c)O_(2)降低增加术后早期认知功能减退的发生率。OLV期间的最低脑氧饱和度(S_(c)O_(2)-min)、S_(c)O_(2)降低绝对值(ΔS_(c)O_(2))和S_(c)O_(2)变异度对术后早期认知功能减退有良好的预测能力,ROC曲线下面积分别为0.752、0.774和0.786(P<0.001),最佳截断值为S_(c)O_(2)-min<58.1%(敏感度66.2%,特异度75.7%),ΔS_(c)O_(2)>7.0%(敏感度77.9%,特异度68.4%),S_(c)O_(2)变异度>10.5%(敏感度77.9%,特异度67.2%)。结论S_(c)O_(2)-min<58.1%、ΔS_(c)O_(2)>7.0%和S_(c)O_(2)变异度>10.5%是术后早期认知功能减退的预警值,可用于指导临床管理。Objective To explore the predictive performance of cerebral oxygen desaturation during one-lung ventilation(OLV)for early postoperative cognitive decline and the warning desaturation thresholds in thoracic surgery.Methods A prospective cohort study was employed for the project.A total of 254 patients were divided into four different groups according to the degree of S cO 2 variation during OLV:S_(c)O_(2)variation<10%(Group D1);10≤S_(c)O_(2)variation<15%(Group D2);15≤S_(c)O_(2)variation<20%(Group D3);S_(c)O_(2)variation≥20%(Group D4).The main outcome was early postoperative cognitive decline.Results Cerebral oxygenation desaturation increased the incidence of early postoperative cognitive decline.The minimal cerebral oxygen saturation(S_(c)O_(2))during OLV(S_(c)O_(2)-min),absolute S_(c)O_(2)drop(ΔS_(c)O_(2))and S_(c)O_(2)variation showed good predictive performance on the occurrence of early postoperative cognitive decline with the areas under ROC curves of 0.752,0.774 and 0.786(P<0.001),respectively.The optimal cutoff values were S_(c)O_(2)-min<58.1%with 66.2%sensitivity and 75.7%specificity,ΔS_(c)O_(2)>7.0%with 77.9%sensitivity and 68.4%specificity,S_(c)O_(2)variation>10.5%with 77.9%sensitivity and 67.2%specificity.Conclusion S_(c)O_(2)-min<58.1%,ΔS_(c)O_(2)>7.0%and S_(c)O_(2)variation>10.5%can be the warning thresholds for early postoperative cognitive decline,which may be used to guide clinical management.

关 键 词：脑组织氧饱和度 术后认知功能减退 胸科手术 

分 类 号：R749.2[医药卫生—神经病学与精神病学]