动态脑自动调节：术后谵妄的标志物？
Dynamic cerebral autoregulation: A marker of post-operative delirium?
机构信息
Department of Anesthesia, University of Sao Paulo, Brazil; Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, Brazil; Critical Care Unit Hospital São Rafael Salvador, Brazil.
Department of Cardiovascular Sciences, University of Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK.
出版信息
Clin Neurophysiol. 2019 Jan;130(1):101-108. doi: 10.1016/j.clinph.2018.11.008. Epub 2018 Nov 22.
OBJECTIVE
We investigated the potential association of cerebral autoregulation (CA) with postoperative delirium (PD), a common complication of cardiac surgery with cardiopulmonary bypass (CPB).
METHODS
In patients undergoing coronary artery bypass graft (CABG) surgery with CPB, cerebral blood flow velocity (CBFV) and blood pressure (BP) were continuously recorded during 5-min preoperatively (T1), after 24 h (T2), and 7 days after procedure (T3). Prospective multivariate logistic regression analysis was performed to determine the independent risk factors of PD. Autoregulation index (ARI) was calculated from the CBFV response to a step change in BP derived by transfer function analysis.
RESULTS
In 67 patients, mean age 64.3 ± 9.5 years, CA was depressed at T2 as shown by values of ARI (3.9 ± 1.7), compared to T1 (5.6 ± 1.7) and T3 (5.5 ± 1.8) (p < 0.001). Impaired CA was found in 37 (55%) patients at T2 and in 7 patients (20%) at T3. Lower ARI at T1 and T2 were predictors of PD (p = 0.003).
CONCLUSION
Dynamic CA was impaired after CABG surgery with CPB and was a significant independent risk factor of PD.
SIGNIFICANCE
Assessment of CA before and after surgery could have considerable potential for early identification of patients at risk of PD, thus reducing poor outcomes and length of stay.
CLINICAL TRIALS REGISTRATION
www.clinicaltrials.gov (NCT02143544, April 30, 2014).
目的
我们研究了脑自动调节（CA）与心脏手术后并发谵妄（PD）的潜在关联，后者是体外循环（CPB）下心脏手术的常见并发症。
方法
在接受 CPB 下冠状动脉旁路移植（CABG）手术的患者中，在术前 5 分钟（T1）、术后 24 小时（T2）和术后 7 天（T3）连续记录脑血流速度（CBFV）和血压（BP）。采用前瞻性多变量逻辑回归分析确定 PD 的独立危险因素。通过传递函数分析从 BP 的阶跃变化得出 CBFV 响应，计算自动调节指数（ARI）。
结果
在 67 名患者中，平均年龄 64.3±9.5 岁，与 T1（5.6±1.7）和 T3（5.5±1.8）相比，T2 时 ARI 值（3.9±1.7）表明 CA 受到抑制（p<0.001）。在 T2 时发现 37 名（55%）患者的 CA 受损，在 T3 时发现 7 名（20%）患者的 CA 受损。T1 和 T2 时较低的 ARI 是 PD 的预测因素（p=0.003）。
结论
CPB 下 CABG 手术后动态 CA 受损，是 PD 的显著独立危险因素。
意义
手术前后 CA 的评估可能具有早期识别 PD 风险患者的巨大潜力，从而降低不良预后和住院时间。
临床试验注册
www.clinicaltrials.gov（NCT02143544，2014 年 4 月 30 日）。
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