Li Hongyi, Fu Qiaochu, Wu Zongfang, Sun Jiaoli, Manyande Anne, Yang Hui, Wang Peng
Department of Anesthesiology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, 100730, People's Republic of China.
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.
J Clin Monit Comput. 2018 Apr;32(2):285-293. doi: 10.1007/s10877-017-0024-0. Epub 2017 May 9.
Hypertensive patients are more likely to experience latent cerebral ischemia causing regional cerebral oxygen saturation (rSO) decrease during general anesthesia. The aim of this prospective observational study was to assess the incidence of decreased rSO in hypertensive patients undergoing major abdominal surgery and the perioperative factors affecting this change in rSO. A total of 41 hypertensive patients were enrolled and stratified according to their hypertension as controlled and uncontrolled. The intraoperative rSO and physiological data were routinely collected. The Mini-Mental State Exam (MMSE) was used to test cognitive function before surgery and after 4 days. Cerebral desaturation was defined as a decrease in rSO of more than 20% of the baseline value. There were 20 patients (49%) suffering intraoperative cerebral desaturation classified into cerebral desaturation group (group D) and those 21 without intraoperative desaturation classified into normal group (group N). The area under the curve below 90 and 80% of baseline (AUC and AUC) was lower in patients of group N (2752.4 ± 1453.3 min% and 0.0 min%) than in patients of group D (6264.9 ± 1832.3 min% and 4486.5 ± 1664.9 min%, P < 0.001). Comparing the two groups, the number of uncontrolled hypertensive individuals in group D (12/20) was significantly more than group N (4/21) (P = 0.007). A significant correlation was observed between relative decrease in MAP and relative decrease in rSO (r = 0.495, P < 0.001). Moreover, nine patients (45%) in group D occurred early postoperative cognitive function decline were more than three patients (14.3%) in group N (P = 0.031). This pilot study showed a large proportion of hypertensive patient experienced cerebral desaturation during major abdominal surgery and uncontrolled hypertension predisposed to this desaturation. NCT02147275 (registered at http://www.clinicaltrials.gov ).
高血压患者在全身麻醉期间更易发生潜在性脑缺血，导致局部脑氧饱和度（rSO）降低。这项前瞻性观察性研究的目的是评估接受腹部大手术的高血压患者rSO降低的发生率以及影响rSO这一变化的围手术期因素。共纳入41例高血压患者，并根据其高血压是否得到控制进行分层。常规收集术中rSO和生理数据。使用简易精神状态检查表（MMSE）在手术前和术后4天测试认知功能。脑去饱和被定义为rSO较基线值降低超过20%。有20例患者（49%）术中发生脑去饱和，分为脑去饱和组（D组），21例未发生术中去饱和的患者分为正常组（N组）。N组患者基线值低于90%和80%时的曲线下面积（AUC和AUC）（分别为2752.4±1453.3分钟%和0.0分钟%）低于D组患者（分别为6264.9±1832.3分钟%和4486.5±1664.9分钟%，P<0.001）。比较两组，D组未控制高血压的个体数量（12/20）显著多于N组（4/21）（P=0.007）。观察到平均动脉压（MAP）的相对降低与rSO的相对降低之间存在显著相关性（r=0.495，P<0.001）。此外，D组9例患者（45%）术后早期出现认知功能下降，多于N组3例患者（14.
