脑氧监测下机器人辅助根治性膀胱切除术（RARC）术后认知功能障碍：一项观察性前瞻性队列研究。
Postoperative cognitive dysfunction after robot-assisted radical cystectomy (RARC) with cerebral oxygen monitoring an observational prospective cohort pilot study.
机构信息
Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pujian Road, Shanghai, 200127, China.
出版信息
BMC Anesthesiol. 2019 Nov 6;19(1):202. doi: 10.1186/s12871-019-0877-5.
BACKGROUND
The incidence and risk factors of postoperative cognitive dysfunction (POCD) during robot-assisted radical cystectomy (RARC) in extreme Trendelenburg positioning and pneumoperitoneum are still controversial. The aim of this prospective observational study was to find the incidence rate as well as possible risk factors of POCD in RARC with cerebral oxygen monitoring.
METHODS
Patients who underwent RARC and open abdominal surgery in horizontal positioning were included. Preoperative and postoperative arterial blood gas (ABG), S-100β, C-reactive protein (CRP), and cognitive dysfunction scales were tested. Also, we used Z score to analyze and comprehensively evaluate POCD. Measurements of heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), end-tidal CO (etCO), and cerebral oxygen were immediately obtained after different time points during the surgery.
RESULTS
Here, 24 and 23 patients were included in the RARC group and in the control group, respectively. The incidence of POCD didn't have significant difference in RARC group (45.8%), in contrast to the control group (26.1%). The laboratory tests of s100β and CRP between two groups didn't contain significant difference as well. As duration of Trendelenburg and pneumoperitoneum prolonged, the cerebral oxygen saturation in the RARC group increased, which didn't cause excessive perfusion nevertheless (rSO<75%). We compared laboratory tests, age, education status, blood loss, and fluid input between POCD and non-POCD patients. A significant difference was found in the serum concentrations of CRP (72.59 ± 42.09 vs. 48.50 ± 26.53, P = 0.025) and age (69.20 ± 7.033 vs. 65.34 ± 5.228, P = 0.041).
CONCLUSION
RARC in extreme Trendelenburg positioning and pneumoperitoneum did not significantly increase the incidence of POCD and didn't cause excessive perfusion. The inflammation marker CRP and age might be independent risk factors of POCD.
TRIAL REGISTRATION
Clinicaltrials.gov with registration number NCT03372135 . Registered 1 November 2017 (retrospectively registered).
背景
在极端特伦德伦堡体位和气腹下机器人辅助根治性膀胱切除术（RARC）术后认知功能障碍（POCD）的发生率和危险因素仍存在争议。本前瞻性观察研究的目的是在使用脑氧监测的情况下，寻找 RARC 中 POCD 的发生率以及可能的危险因素。
方法
纳入接受 RARC 和水平体位开放手术的患者。术前和术后均进行动脉血气（ABG）、S-100β、C 反应蛋白（CRP）和认知功能障碍量表测试。此外，我们使用 Z 评分进行分析，综合评估 POCD。在手术过程中的不同时间点，立即测量心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、呼气末 CO（etCO）和脑氧。
结果
RARC 组和对照组分别纳入 24 例和 23 例患者。RARC 组 POCD 的发生率（45.8%）与对照组（26.1%）无显著差异。两组间 s100β和 CRP 的实验室检查结果也无显著差异。随着特伦德伦堡体位和气腹时间的延长，RARC 组脑氧饱和度增加，但并未导致过度灌注（rSO<75%）。我们比较了 POCD 和非 POCD 患者的实验室检查、年龄、教育程度、出血量和液体输入。CRP 血清浓度（72.59±42.09 比 48.50±26.53，P=0.025）和年龄（69.20±7.033 比 65.34±5.228，P=0.041）的差异有统计学意义。
结论
在极端特伦德伦堡体位和气腹下进行 RARC 并未显著增加 POCD 的发生率，也未导致过度灌注。炎症标志物 CRP 和年龄可能是 POCD 的独立危险因素。
试验注册
Clinicaltrials.gov 注册号 NCT03372135。于 2017 年 11 月 1 日（追溯注册）注册。
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