Saha Shekhar, Karaca Kübra, Jebran Ahmad Fawad, Waezi Narges, Ort Katharina, Brandes Ivo, Hagl Christian, Niehaus Heidi
Department of Thoracic and Cardiovascular Surgery, University Hospital, Georg-August-University, Göttingen, Germany.
Department of Cardiac Surgery, Ludwig Maximilian University, München, Germany.
Thorac Cardiovasc Surg. 2021 Dec;69(8):693-699. doi: 10.1055/s-0040-1716897. Epub 2020 Nov 20.
Depression of cholinesterase (CHE) activity has been reported to lead to an amplified neuroinflammatory response, which clinically manifests as postoperative delirium (PD). This observational study investigates the association between CHE activity and the development of PD following elective cardiac surgery.
Patients with preexisting neurologic deficits or carotid artery disease as well as patients undergoing reoperations or procedures under circulatory arrest have been excluded from this study. The Mini-Mental State Examination, the Confusion Assessment Method for the Intensive Care Unit, and the Intensive Care Delirium Screening Checklist were performed at regular intervals. CHE activity was estimated pre- and postoperatively until postoperative day (POD) 5 and at discharge.
A total of 107 patients were included. PD was diagnosed in 34 (31.8%) patients, who have been compared with those without PD. Time on ventilator, length of ICU, and hospital stay were longer in patients with PD ( = 0.001, < 0.001, and = 0.004, respectively). MMSE scores were lower in patients with PD ( < 0.001; = 0.015). CHE activity on POD 1 to 4 as well as at discharge were lower in the delirium group ( = 0.041; = 0.029; = 0.015; = 0.035; = 0.028, respectively). A perioperative drop of CHE activity of more than 50% and a postoperative CHE activity below 4,800 U/L (on POD 0) were independently associated with an increased risk of development of PD ( = 0.038; = 0.008, respectively).
In addition to the established functional tests, routine estimation of CHE activity may serve as an additional diagnostic tool allowing for the timely diagnosis and treatment of PD in cardiac surgery patients.
据报道，胆碱酯酶（CHE）活性降低会导致神经炎症反应增强，临床上表现为术后谵妄（PD）。这项观察性研究调查了择期心脏手术后CHE活性与PD发生之间的关联。
本研究排除了既往有神经功能缺损或颈动脉疾病的患者，以及接受再次手术或循环骤停手术的患者。定期进行简易精神状态检查、重症监护病房意识模糊评估方法和重症监护谵妄筛查清单评估。术前和术后直至术后第5天（POD）及出院时评估CHE活性。
共纳入107例患者。34例（31.8%）患者被诊断为PD，并与未发生PD的患者进行比较。发生PD的患者机械通气时间、重症监护病房住院时间和住院时间更长（分别为P = 0.001、P < 0.001和P = 0.004）。发生PD的患者简易精神状态检查表评分更低（P < 0.001；P = 0.015）。谵妄组术后第1至4天及出院时的CHE活性更低（分别为P = 0.041；P = 0.029；P = 0.015；P = 0.035；P = 0.028）。围手术期CHE活性下降超过50%以及术后CHE活性低于4800 U/L（术后第0天）与发生PD的风险增加独立相关（分别为P = 0.038；P = 0.008）。
除了已有的功能测试外，CHE活性的常规评估可作为一种额外的诊断工具，有助于及时诊断和治疗心脏手术患者的PD。
