Department of Anaesthesiology and Postoperative Intensive Care, University of Ioannina School of Medicine, Ioannina, Greece.
Injury. 2011 Nov;42(11):1328-32. doi: 10.1016/j.injury.2011.04.015. Epub 2011 May 31.
This study was conducted to evaluate baseline cerebral tissue regional oxygen saturation (rSO(2)) values and identify risk factors related to severe rSO(2) reductions in elderly patients with hip fractures.
This was a prospective observational single-centre study on patients undergoing scheduled or urgent operation for isolated hip fracture. The study was approved by the Institution Ethics Committee, and all patients signed informed consent before entering the study. Data were collected on factors potentially related to baseline cerebral rSO(2). Data were analysed with Student's t-test, Pearson's correlation or multiple regression analysis as appropriate.
Sixty-nine patients, aged (mean±standard deviation (SD)) 74±13 years participated. Left baseline rSO(2) was 60.09±10.20 and right baseline rSO(2) was 58.64±9.92. Baseline rSO(2)<45 was observed in 10.1% of patients on the left and 8.7% on the right side. Correlation between left- and right-side baseline cerebral rSO(2) was highly significant (r=0.852, p<0.001). Baseline cerebral rSO(2) had a positive, highly significant correlation with preoperative haematocrit (r=0.50, p<0.001) and arterial haemoglobin oxygen saturation (SpO(2)) (r=0.587, p<0.001), but correlation was negative with the American Society of Anesthesiologists (ASA) physical status (r=-0.42, p<0.001) and age (r=-0.39, p=0.001). Linear regression showed that preoperative haematocrit accounts for 23% (R(2)=0.23) of baseline rSO(2) variability, whereas preoperative haematocrit and SpO(2) combined account for 43.7% of rSO(2) variability (R(2)=0.437). Combined preoperative haematocrit+SpO(2)+age accounted for 51.3% (R(2)=0.513) of observed rSO(2) variability.
Low baseline cerebral rSO(2) values are common in elderly hip fracture patients, despite normal haemodynamic and arterial saturation values. Preoperative haematocrit, SpO(2) and age explain a significant portion of cerebral rSO(2) variability. More studies are needed to validate our findings and assess the potential benefit of interventions aimed at improving cerebral rSO(2) in elderly hip fracture patients.
本研究旨在评估老年髋部骨折患者的基线脑组织局部氧饱和度（rSO(2)）值，并确定与严重 rSO(2)降低相关的风险因素。
这是一项针对因髋部骨折拟行择期或紧急手术的患者进行的前瞻性观察性单中心研究。该研究获得了机构伦理委员会的批准，所有患者在入组前均签署了知情同意书。收集了可能与基线脑 rSO(2)相关的因素的数据。使用学生 t 检验、Pearson 相关或多元回归分析进行数据分析。
共有 69 名年龄（平均值±标准差（SD））为 74±13 岁的患者参与了研究。左侧基线 rSO(2)为 60.09±10.20，右侧基线 rSO(2)为 58.64±9.92。左侧基线 rSO(2)<45 的患者占 10.1%，右侧占 8.7%。左侧和右侧基线脑 rSO(2)之间存在高度显著的相关性（r=0.852，p<0.001）。基线脑 rSO(2)与术前血细胞比容（r=0.50，p<0.001）和动脉血氧饱和度（SpO(2)）（r=0.587，p<0.001）呈正相关，与美国麻醉医师协会（ASA）体格状况（r=-0.42，p<0.001）和年龄（r=-0.39，p=0.001）呈负相关。线性回归显示，术前血细胞比容占基线 rSO(2)变异性的 23%（R(2)=0.23），而术前血细胞比容和 SpO(2)联合占 rSO(2)变异性的 43.7%（R(2)=0.437）。术前血细胞比容+SpO(2)+年龄联合占观察到的 rSO(2)变异性的 51.3%（R(2)=0.513）。
尽管血流动力学和动脉饱和度值正常，但老年髋部骨折患者的基线脑 rSO(2)值较低。术前血细胞比容、SpO(2)和年龄解释了脑 rSO(2)变异性的很大一部分。需要更多的研究来验证我们的发现，并评估旨在改善老年髋部骨折患者脑 rSO(2)的干预措施的潜在益处。
