老年脊柱结核手术中脑氧饱和度下降与围术期认知功能障碍的关系  

Correlation between intraoperative cerebral oxygen saturation monitoring decrease and perioperative neurocognitive disorders in elderly patients undergoing spinal tuberculosis surgery

作　　者：赵一鸣 沈心怡 阙彬[3] 余建明 ZHAO Yiming;SHEN Xinyi;QUE Bin;YU Jianming(Department of Anesthesiology,Zhejiang Provincial People's Hospital(Hangzhou Medical College Affiliated People's Hospital),Hangzhou 310014,China;不详)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)麻醉科,杭州310014 [2]杭州市红十字会医院麻醉科 [3]杭州市中医院麻醉科 [4]杭州市第三人民医院麻醉科

出　　处：《浙江医学》2024年第4期398-402,共5页Zhejiang Medical Journal

基　　金：杭州市卫生科技计划重点项目(ZD20200092)。

摘　　要：目的 探讨老年脊柱结核患者手术中脑氧饱和度(rSO_(2))下降与围术期认知功能障碍(PND)的关系。方法 选取2019年10月至2023年7月在杭州市红十字会医院和浙江省人民医院行脊柱结核手术的患者共136例,应用rSO_(2)监测仪监测rSO_(2)变化。记录患者入手术室面罩以6 L/min的氧流量吸氧2 min(T_(0))、气管插管后5 min(T_(1))、俯卧位30 min(T_(2))、俯卧位1 h(T_(3))、俯卧位2 h(T_(4))、侧卧位病灶清除(T_(5))和术毕时(T_(6))的左右两侧rSO_(2)值及生命体征情况。分别于术前1天、术后第3、7天应用简易精神状态量表(MMSE)评估患者认知功能,根据评估结果分为PND组和非PND组,比较两组患者术中rSO_(2)的差异和术后ICU入住时间。结果 136例脊柱结核手术患者分为PND组34例和非PND组102例,PND发生率25.0%。PND组rSO_(2)下降20.0%的比例(44.1%)高于非PND组(14.7%),差异有统计学意义(P<0.05);术后第3、7天MMSE评分均低于非PND组,差异均有统计学意义(均P<0.05);PND组在T_(5)时点的平均动脉压、rSO_(2)均低于非PND组,差异均有统计学意义(均P<0.05);PND组患者术后ICU入住时间长于非PND组,差异有统计学意义(P<0.05)。结论 术中rSO_(2)值下降超过术前值的20.0%是PND的预测因素;术中rSO_(2)急速下降主要发生在病灶清除过程中;PND的发生与术中低血压有关。Objective To investigate the correlation between intraoperative decrease of cerebral regional oxygen saturation monitoring(rSO_2) and perioperative neurocognitive disorders(PND) in elderly patients undergoing spinal tuberculosis surgery.Methods A total of 136 elderly patients who underwent spinal tuberculosis surgery at Hangzhou Red Cross Hospital and Zhejiang Provincial People's Hospital from October 2019 to July 2023 were enrolled in the study.The changes of rSO_(2) were monitored by cerebral oxygen saturation monitor,and the bilateral rSO_(2) values were recorded after inhaling 6 L/min of oxygen for 2 min(T_0),5 min after tracheal intubation(T_1),30 min after prone position(T_2),1 h after prone position(T_3),2 h after prone position(T_4),debridement of lesions in lateral position(T_5),and at the end of surgery(T_6).The cognitive function of patients was assessed with mini-mental state examination(MMSE) 1 d before operation,d3 and d7 after operation.According to the evaluation results,the patients were divided into PND group and non-PND group,and the rSO_(2) between the two groups during operation was compared at various time points.Results There were 34 cases in PND group and 102 cases in non-PND group.The proportion of 20% reduction in rSO_(2) in PND group was significantly higher than that in non-PND group(44.1% vs.14.7%,P<0.05).The MMSE scores of the PND group were significantly lower than those of the non-PND group at d3 and d7 after surgery(P<0.05).The mean arterial pressure and rSO_(2) of the PND group were significantly lower than non-PND group at time point T_5(P<0.05).The length of postoperative ICU stay in PND group was significantly longer than that in non-PND group(P<0.05).Conclusion The decrease of rSO_(2) value more than 20.0% of the preoperative value during operation is a predictive factor of PND.The sharp decrease of rSO_(2) during the operation mainly occurred in the process of debridement of lesions.The occurrence of PND is associated with intraoperative hypotension.

关 键 词：围术期神经认知功能障碍 脑氧饱和度 老年患者 

分 类 号：R614[医药卫生—麻醉学]