Qin X W, Chen X L, Yao L
Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China.
Zhonghua Yi Xue Za Zhi. 2021 Feb 2;101(5):345-349. doi: 10.3760/cma.j.cn112137-20200527-01681.
To investigate the effect of cerebral oxygen saturation (rSO) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing cardiac anesthesia. Retrospective analysis was performed on 113 elderly patients (age 65-89) underwent cardiac surgery in Peking University International Hospital from June 2017 to December 2019, 67 male and 46 female patients were included. All operations were performed under general anesthesia, cardiopulmonary bypass, rSO and other relevant monitoring. Statistical analysis of the elderly patients with complications, cardiac surgery history, time of CPB, baseline value of rSO (rSO ), lowest intraoperative value of rSO (rSO), time of operation, length of stay in CCU, length of hospital stay; Preoperative and postoperative NSE values; number of postoperative POCD and postoperative deaths were recorded. All data were obtained from the medical records system and anesthesia information system of Peking University International Hospital and risk factors related to POCD were analyzed by Logistic regression. POCD occurred in 19 patients (16.8%), and also, intraoperative rSO decreased by more than 30% over the baseline. The variance of rSO (rSO-rSO) in POCD group and non-POCD group was (18.0±2.7) and (6.6±2.3), the variance of NSE (NSE -NSE ) was (31.3±9.7) and (9.5±3.0) μg/L, respectively. The differences were statistically significant (=18.35, 17.70, all <0.05). rSO variability was positively correlated with NSE variability (=0.697, <0.05). Logistic regression analysis showed that the variation degree of rSO [(95%)was 0.374(0.059-1.895)]、 patients combined with diabetes mellitus [(95%)was 0.493 (0.041-1.812), history of stroke [(95%)was 0.325 (0.084-0.917)] and atrial fibrillation [(95%)was 0.176 (0.091-0.943)] were the risk factors for POCD. POCD can be predicted by monitoring the decline range of rSO intraoperatively. rSO is recommended as a routine monitoring item for elderly patients undergoing cardiac surgery.
探讨脑氧饱和度（rSO）对老年心脏麻醉患者术后认知功能障碍（POCD）的影响。对2017年6月至2019年12月在北京大学国际医院接受心脏手术的113例老年患者（年龄65 - 89岁）进行回顾性分析，其中男性67例，女性46例。所有手术均在全身麻醉、体外循环、rSO等相关监测下进行。对老年患者的并发症、心脏手术史、体外循环时间、rSO基线值（rSO ）、术中rSO最低值（rSO）、手术时间、CCU住院时间、住院时间；术前和术后NSE值；术后POCD发生例数及术后死亡例数进行统计分析。所有数据均来自北京大学国际医院的病历系统和麻醉信息系统，并通过Logistic回归分析POCD相关危险因素。19例患者（16.8%）发生POCD，且术中rSO较基线值下降超过30%。POCD组和非POCD组rSO的差值（rSO - rSO）分别为（18.0±2.7）和（6.6±2.3），NSE的差值（NSE - NSE ）分别为（31.3±9.7）和（9.5±3.0）μg/L。差异有统计学意义（=18.35，17.70，均<0.05）。rSO变异性与NSE变异性呈正相关（=0.697，<0.05）。Logistic回归分析显示，rSO的变化程度[（95%）为0.374（0.059 - 1.895）]、合并糖尿病患者[（95%）为0.493（0.041 - 1.812）]、有卒中史[（95%）为0.325（0.084 - 0.917）]和心房颤动[（95%）为0.176（0.091 - 0.943）]是POCD的危险因素。术中监测rSO下降幅度可预测POCD。建议将rSO作为老年心脏手术患者的常规监测项目。
