老年心脏手术患者术后精神分裂与脑氧饱和度降低的关系

Association Between Postoperative Delirium and Postoperative Cerebral Oxygen Desaturation in Older Patients After Cardiac Surgery

练成枕叶氧相对于下降与自主神经系统出血涉及。我们可用近红外光谱非肾结石地测定局部大脑氧相对于。本次研究工作推论了瓣膜手练成后老年病患围练成期脑氧相对于下降是否与练成后自主神经系统出血涉及。

在2015年至2017年期在在，我们将70岁及以上计划进行瓣膜手练成的病患归入一项单外围、革新、推论性研究工作。练成前一天测定所有病患脑氧相对于框架值。在练成中及ICU连续监测病患脑氧相对于至练成后72h。可用ICU病患意识模糊分析报告单（Confusion assessment method for the ICU，CAM-ICU）分析报告中毒者，采用非校正分析和多给定Logistic重回分析赞扬其与中毒者的涉及性。

共计103例病患被归入这项革新推论性研究工作，剔除不反之亦然的病患后事与愿违共96例病患被归入数据分析，其中29例（30%）病患消失练成后中毒者。练成枕叶氧相对于下降与练成后中毒者无相对来说来说涉及性。与无中毒者病患相比，中毒者病患练成后最低脑氧相对于低，且中毒者病患练成后脑氧相对于的乘积相对来说下降更相对来说来说;无关脑氧相对于心理因素后，病患在在其它差异不相对来说来说。高龄、发作史、较高的EuroSCORE II评级、练成前MMSE评级低、练成后较相对来说来说的脑氧相对于乘积下降均与练成后中毒者的发生独立涉及。

遵从体外循环瓣膜手练成的老年病患练成后中毒者与脑氧相对于下降有关，相比之下在中毒者发作后观感颇为相对来说来说。

Eertmans W,De Deyne C,Genbrugge C,et al.Association Between Postoperative Delirium and Postoperative Cerebral Oxygen Desaturation in Older Patients After Cardiac Surgery. Br J Anaesth 2020; 124 (2): 146-153.

Background: Near-infrared spectroscopy non-invasively measures regional cerebral oxygen saturation. Intraoperative cerebral desaturations he been associated with worse neurological outcomes. We investigated whether perioperative cerebral desaturations are associated with postoperative delirium in older patients after cardiac surgery.Methods: Patients aged 70 yr and older scheduled for on-pump cardiac surgery were included between 2015 and 2017 in a single-centre, prospective, observational study. Baseline cerebral oxygen saturation was measured 1 day before surgery.Throughout surgery and after ICU admission, cerebral oxygen saturation was monitored continuously up to 72 h after operation. The presence of delirium was assessed using the confusion assessment method for the ICU. Association with delirium was evaluated with unadjusted yses and multivariable logistic regression.Results: Ninety-six of 103 patients were included, and 29 (30%) became delirious. Intraoperative cerebral oxygen saturation was not significantly associated with postoperative delirium. The lowest postoperative cerebral oxygen saturation was lower in patients who became delirious (P¼0.001). The absolute and relative postoperative cerebral oxygen saturation decreases were more marked in patients with delirium (13 [6]% and 19 [9]%, respectively) compared with patients without delirium (9 [4]% and 14 [5]%; P¼0.002 and P¼0.001, respectively). These differences in cerebral oxygen saturation were no longer present after excluding cerebral oxygen saturation values after patients became delirious. Older age,previous stroke, higher EuroSCORE II, lower preoperative Mini-Mental Status Examination, and more substantial absolute postoperative cerebral oxygen saturation decreases were independently associated with postoperative delirium incidence.Conclusions: Postoperative delirium in older patients undergoing cardiac surgery is associated with absolute decreases in postoperative cerebral oxygen saturation. These differences appear most detectable after the onset of delirium.