Departments of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Department of Psychiatry, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Anaesthesia. 2017 Dec;72(12):1456-1466. doi: 10.1111/anae.14056. Epub 2017 Sep 22.
Postoperative delirium is associated with increased morbidity and mortality. We hypothesised that restoration of regional cerebral oxygen desaturation would reduce the incidence of postoperative delirium in elderly patients after cardiac surgery. After institutional ethics review board approval and informed consent, a double-blinded, prospective, randomised, controlled trial was conducted in patients ≥ 60 years of age undergoing cardiac surgery with cardiopulmonary bypass. In the intervention group, an algorithm was commenced if regional cerebral oxygen saturation decreased below 75% of baseline value for 1 min or longer. In the control group, the cerebral oximetry monitor screen was electronically blinded. Assessment of delirium was performed with confusion assessment method for intensive care unit or confusion assessment method after discharge from intensive care unit at 12-h intervals for seven postoperative days. Postoperative delirium was present in 30 out of 123 (24.4%) and 31 out of 126 (24.6%) patients in the intervention and control groups, respectively, odds ratio 0.98 (95%CI 0.55-1.76), p = 0.97. Postoperative delirium was present in 20 (71%) out of 28 and in 41 (18%) out of 221 patients with baseline regional cerebral oxygen saturation ≤ 50, or > 50%, respectively, p = 0.0001. Higher baseline regional cerebral oxygen saturation and body mass index were protective against postoperative delirium. Restoration of regional cerebral oxygen desaturation did not result in lower postoperative delirium after cardiac surgery. Pre-operative regional cerebral oxygen saturation ≤ 50% was associated with increased postoperative delirium rates in elderly patients following cardiac surgery.
术后谵妄与发病率和死亡率增加有关。我们假设恢复区域性脑氧饱和度降低将减少老年患者心脏手术后术后谵妄的发生率。在机构伦理审查委员会批准和知情同意后，对 60 岁以上接受体外循环心脏手术的患者进行了双盲、前瞻性、随机、对照试验。在干预组中，如果区域性脑氧饱和度下降到基线值的 75%以下 1 分钟或更长时间，则开始使用算法。在对照组中，脑氧饱和度监测器屏幕被电子屏蔽。术后谵妄评估采用重症监护病房意识模糊评估法或重症监护病房出院后 12 小时间隔 7 天进行的意识模糊评估法。在干预组和对照组中，分别有 30 例（24.4%）和 31 例（24.6%）患者出现术后谵妄，优势比为 0.98（95%CI 0.55-1.76），p=0.97。在基线区域性脑氧饱和度≤50%或>50%的 28 例和 221 例患者中，分别有 20 例（71%）和 41 例（18%）出现术后谵妄，p=0.0001。较高的基线区域性脑氧饱和度和体重指数对术后谵妄有保护作用。心脏手术后，恢复区域性脑氧饱和度降低并不会导致术后谵妄发生率降低。术前区域性脑氧饱和度≤50%与老年患者心脏手术后术后谵妄发生率增加相关。
