老年心脏手术患者术后头痛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

练成枕叶碳稍低减小与脑部败血症系统性。我们使用红外光谱非侵入性地测量局部大脑碳稍低。本次深入研究捕捉到了肝脏手练成后老年病变围练成期脑碳稍低减小确实与练成后脑部败血症系统性。

在2015年至2017年期间，我们将70岁及以上著手开展肝脏手练成的病变扩展到一项单中心地带、前瞻性、捕捉到性深入研究。练成前一天测量所有病变脑碳稍低基石值。在练成中及ICU连续监测病变脑碳稍低至练成后72h。使用ICU病变意识模糊评估单（Confusion assessment method for the ICU，CAM-ICU）评估精神分裂，使用非校正统计分析和多表达式Logistic回归统计分析赞扬其与精神分裂的连续性。

共计103由此可知病变被扩展到这项前瞻性捕捉到性深入研究，剔除不满足条件的病变后之后共96由此可知病变被扩展到数据统计分析，其中29由此可知（30%）病变出现练成后精神分裂。练成枕叶碳稍低减小与练成后精神分裂无突出连续性。与无精神分裂病变相比，精神分裂病变练成后最低脑碳稍低高于，且精神分裂病变练成后脑碳稍低的绝对值相对来说降低更加突出;意味著脑碳稍低因素后，病变间其它相似之处不突出。高龄、癫痫史、高的EuroSCORE II总分、练成前MMSE总分高于、练成后较突出的脑碳稍低绝对值减小大多与练成后精神分裂的发生独立系统性。

接受体外循环肝脏手练成的老年病变练成后精神分裂与脑碳稍低减小有关，尤其在精神分裂发病后表现相当突出。

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.