Hong Seong Wook, Shim Jae Kwang, Choi Yong Seon, Kim Dae Hee, Chang Byung Chul, Kwak Young Lan
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 134 Shinchon-Dong, Seadaemun-Ku, Seoul 120-752, South Korea.
Eur J Cardiothorac Surg. 2008 Apr;33(4):560-5. doi: 10.1016/j.ejcts.2008.01.012. Epub 2008 Feb 12.
Postoperative cognitive dysfunction (POCD) commonly develops after cardiac surgery affecting patients' outcome. Cerebral oximetry noninvasively measures regional cerebral oxygen saturation (rSO(2)) and significant correlation has been reported between intraoperative cerebral desaturation and POCD, as well as patients' outcome following coronary artery bypass grafting. However, evidence is limited in valvular heart surgery (VHS). We investigated the relationship of intraoperative rSO(2) values with POCD and length of postoperative hospitalization in patients undergoing VHS.
One hundred patients undergoing elective VHS were enrolled. Neurocognitive evaluation was performed with Mini-Mental State Examination, Trail-Making Test (Part A), and Grooved Pegboard Test at 1 day before and 7th day after surgery. During surgery, rSO(2) was continuously monitored and the incidence and duration of decrease in rSO(2) values for five consecutive minutes were recorded as follows; (1) decrease in absolute rSO(2) values to less than 50%, (2) 40%, and (3) a 20% decrease compared to baseline value.
Twenty-three patients (23%) demonstrated POCD. We could not observe any significant differences in either the incidence or duration of decrease in rSO(2) values between patients with and without POCD. Low education level and higher baseline temperature had significant correlation with POCD. Patients with cerebral desaturation required significantly longer postoperative hospitalization.
In patients undergoing VHS, POCD could not be predicted with cerebral oximetry. However, patients with intraoperative cerebral desaturation required significantly longer postoperative hospitalization and cerebral oximetry appears to be promising in terms of monitoring the brain as the index organ for systemic perfusion and improving patients' outcome.
心脏手术后常发生术后认知功能障碍（POCD），影响患者预后。脑血氧饱和度测定法可无创测量局部脑氧饱和度（rSO₂），已有报道称术中脑氧饱和度降低与POCD以及冠状动脉搭桥术后患者的预后之间存在显著相关性。然而，在心脏瓣膜手术（VHS）中证据有限。我们研究了接受VHS患者术中rSO₂值与POCD及术后住院时间的关系。
纳入100例行择期VHS的患者。在手术前1天和术后第7天，采用简易精神状态检查表、连线测验（A部分）和槽板测试进行神经认知评估。手术期间，持续监测rSO₂，并记录rSO₂值连续五分钟下降的发生率和持续时间，具体如下：（1）绝对rSO₂值降至低于50%，（2）40%，以及（3）相较于基线值下降20%。
23例患者（23%）出现POCD。我们未观察到发生POCD与未发生POCD的患者在rSO₂值下降的发生率或持续时间上有任何显著差异。低教育水平和较高的基线体温与POCD显著相关。脑氧饱和度降低的患者术后住院时间显著更长。
在接受VHS的患者中，无法用脑血氧饱和度测定法预测POCD。然而，术中脑氧饱和度降低的患者术后住院时间显著更长，并且脑血氧饱和度测定法在监测作为全身灌注指标器官的大脑以及改善患者预后方面似乎很有前景。
