Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Psychology, National Cheng Kung University, Tainan, Taiwan.
J Cardiothorac Vasc Anesth. 2023 May;37(5):715-723. doi: 10.1053/j.jvca.2023.01.025. Epub 2023 Feb 2.
Cognitive impairment is a common neurologic complication after cardiac surgery with cardiopulmonary bypass (CPB). This study evaluated postoperative cognitive function to determine predictors of cognitive dysfunction, including intraoperative cerebral regional tissue oxygen saturation (rSO).
A prospective observational cohort study.
At a single academic tertiary-care center.
A total of 60 adults undergoing cardiac surgery with CPB from January to August 2021.
None.
All patients underwent Mini-Mental State Examination (MMSE) and quantified electroencephalography (qEEG) 1 day before cardiac surgery, 7 days postoperatively (POD7), and POD60. Intraoperative cerebral rSO was monitored continuously. For MMSE, no significant decrease in MMSE score was found on POD7 versus preoperatively (p = 0.09), but POD60 scores showed significant improvement compared with both preoperative (p = 0.02) and POD7 scores (p < 0.001). On qEEG, relative theta power on POD7 was increased versus preoperatively (p < 0.001), but it was decreased on POD60 (POD7 versus POD60, p < 0.001), and was close to preoperative data (p > 0.99). Baseline rSO was an independent factor for postoperative MMSE. Both baseline and mean rSO showed a significant influence in postoperative relative theta activity, whereas mean rSO was the only predictor for the theta-gamma ratio (p = 0.04).
The MMSE in patients undergoing CPB declined at POD7 and recovered by POD60. Lower baseline rSO indicated a higher potential for MMSE decline at POD60. Inferior intraoperative mean rSO was related to higher postoperative relative theta activity and theta-gamma ratio, implying subclinical or further cognitive impairment.
心肺转流（CPB）心脏手术后认知障碍是一种常见的神经系统并发症。本研究评估了术后认知功能，以确定认知功能障碍的预测因素，包括术中脑局部组织氧饱和度（rSO2）。
前瞻性观察队列研究。
单家学术性三级保健中心。
共纳入 2021 年 1 月至 8 月期间行 CPB 心脏手术的 60 例成人患者。
无。
所有患者在心脏手术前 1 天（术前）、术后第 7 天（术后第 7 天，POD7）和术后第 60 天（POD60）进行了简易精神状态检查（MMSE）和量化脑电图（qEEG）。术中连续监测脑 rSO2。对于 MMSE，POD7 与术前相比，MMSE 评分无显著下降（p=0.09），但与术前（p=0.02）和 POD7 评分（p<0.001）相比，POD60 评分显著改善。qEEG 显示，POD7 时相对θ功率较术前增加（p<0.001），但 POD60 时减少（POD7 与 POD60 相比，p<0.001），与术前数据相近（p>0.99）。基线 rSO2 是术后 MMSE 的独立因素。基线和平均 rSO2 对术后相对θ活动均有显著影响，而平均 rSO2 是θ-γ比值的唯一预测因子（p=0.04）。
CPB 心脏手术后患者的 MMSE 在 POD7 时下降，在 POD60 时恢复。较低的基线 rSO2 表明 POD60 时 MMSE 下降的潜在可能性更高。术中平均 rSO2 较低与术后相对θ活动和θ-γ比值较高相关，提示存在亚临床或进一步的认知障碍。
