脑氧饱和度监测控制性降压对麻醉患者脑保护及认知的影响  

Impact of controlled hypotension by cerebral oxygen saturation monitoring on brain protection and cognitive function in anesthesia patients

作　　者：贺曼曼 何平[1] 史炯[1] 高杨 HE Manman;HE Ping;SHI Jiong;GAO Yang(Department of Anesthesiology,Handan Central Hospital in Hebei Province,Handan,Hebei,056001)

机构地区：[1]河北省邯郸市中心医院麻醉科,河北邯郸056001

出　　处：《实用临床医药杂志》2024年第19期109-113,共5页Journal of Clinical Medicine in Practice

基　　金：河北省2022年度医学科学研究课题计划项目(20220019)。

摘　　要：目的分析脑氧饱和度(rSO_(2))监测控制性降压(CH)对麻醉患者脑保护和认知功能的影响。方法选取行rSO_(2)监测CH麻醉患者200例为研究对象。根据行rSO_(2)监测CH患者术后是否发生围术期神经认知障碍(PND)分为正常组(n=137)和PND组(n=63),收集患者治疗前临床资料。采用单因素分析确定行rSO_(2)监测CH患者术后并发PND的影响因素。采用多因素二元Logistic回归分析法筛选行rSO_(2)监测CH患者术后并发PND的独立危险因素。基于筛选出的独立危险因素构建预测模型,并绘制受试者工作特征(ROC)曲线评估其预测价值。结果年龄、术中出血量、行血管外科手术、术中20 min rSO_(2)监测值、术中20 min中心静脉压(CVP)和合并高血压、脑卒中以及手术时间是行rSO_(2)监测CH患者术后并发PND的影响因素(P<0.05)。患者年龄>55岁、术中20 min CVP高、术中20 min rSO_(2)监测值低及行血管外科手术是行rSO_(2)监测CH患者术后并发PND的独立危险因素(P<0.05)。ROC曲线分析结果显示,预测模型曲线下面积(AUC)为0.855。结论临床可通过控制术中CVP以减少失血量,并依据rSO_(2)监测结果及时调整治疗方案,从而降低行rSO_(2)监测CH患者(年龄>55岁,行血管外科手术)术后并发PND的风险。Objective To analyze the impact of controlled hypotension(CH)by cerebral oxygen saturation(rSO_(2))monitoring on brain protection and cognitive function in anesthetized patients.Methods A total of 200 patients undergoing rSO_(2)-monitored CH were enrolled.Patients were divided into normal group(n=137)and postoperative neurocognitive disorder(PND)group(n=63)based on whether they developed PND after surgery.Preoperative clinical data were collected.Univariate analysis was performed to identify factors influencing the occurrence of PND in rSO_(2)-monitored CH patients.Multivariate binary logistic regression analysis was used to screen for independent risk factors.A predictive model was constructed based on the identified independent risk factors,and its predictive value was evaluated using receiver operating characteristic(ROC)curve analysis.Results Age,intraoperative blood loss,vascular surgery,20-minute rSO_(2) monitoring values,20-minute central venous pressure(CVP),history of hypertension,stroke and operative time were identified as factors affecting the occurrence of PND in rSO_(2)-monitored CH patients(P<0.05).Independent risk factors for PND included age>55 years,high CVP during 20 minutes of surgery,low rSO_(2) monitoring values during 20 minutes and undergoing vascular surgery(P<0.05).ROC curve analysis showed that the area under the curve(AUC)for the predictive model was 0.855.Conclusion Clinically,the risk of PND in rSO_(2)-monitored CH patients(age>55 years,undergoing vascular surgery)can be reduced by controlling intraoperative CVP to minimize blood loss and by timely adjustment of treatment plans based on rSO_(2) monitoring results.

关 键 词：脑氧饱和度监测 控制性降压 脑保护 认知功能障碍 血管外科手术 

分 类 号：R651[医药卫生—外科学] R614[医药卫生—临床医学] R319