Kahl Ursula, Krause Linda, Amin Sabrina, Harler Ulrich, Beck Stefanie, Dohrmann Thorsten, Mewes Caspar, Graefen Markus, Haese Alexander, Zöllner Christian, Fischer Marlene
Departments of Anesthesiology.
Institute of Medical Biometry and Epidemiology.
J Neurosurg Anesthesiol. 2024 Oct 1;36(4):334-340. doi: 10.1097/ANA.0000000000000944. Epub 2023 Nov 27.
Intraoperative impairment of cerebral autoregulation (CA) has been associated with perioperative neurocognitive disorders. We investigated whether intraoperative fluctuations in cardiac index are associated with changes in CA.
We conducted an integrative explorative secondary analysis of individual-level data from 2 prospective observational studies including patients scheduled for radical prostatectomy. We assessed cardiac index by pulse contour analysis and CA as the cerebral oxygenation index (COx) based on near-infrared spectroscopy. We analyzed (1) the cross-correlation between cardiac index and COx, (2) the correlation between the time-weighted average (TWA) of the cardiac index below 2.5 L min -1 m -2 , and the TWA of COx above 0.3, and (3) the difference in areas between the cardiac index curve and the COx curve among various subgroups.
The final analysis included 155 patients. The median cardiac index was 3.16 [IQR: 2.65, 3.72] L min -1 m -2 . Median COx was 0.23 [IQR: 0.12, 0.34]. (1) The median cross-correlation between cardiac index and COx was 0.230 [IQR: 0.186, 0.287]. (2) The correlation (Spearman ρ) between TWA of cardiac index below 2.5 L min -1 m -2 and TWA of COx above 0.3 was 0.095 ( P =0.239). (3) Areas between the cardiac index curve and the COx curve did not differ significantly among subgroups (<65 vs. ≥65 y, P =0.903; 0 vs. ≥1 cardiovascular risk factors, P =0.518; arterial hypertension vs. none, P =0.822; open vs. robot-assisted radical prostatectomy, P =0.699).
We found no meaningful association between intraoperative fluctuations in cardiac index and CA. However, it is possible that a potential association was masked by the influence of anesthesia on CA.
术中脑自动调节功能（CA）受损与围手术期神经认知障碍有关。我们研究了术中心脏指数的波动是否与CA的变化相关。
我们对2项前瞻性观察性研究的个体水平数据进行了综合探索性二次分析，研究对象为计划接受根治性前列腺切除术的患者。我们通过脉搏轮廓分析评估心脏指数，并基于近红外光谱将CA评估为脑氧合指数（COx）。我们分析了（1）心脏指数与COx之间的互相关，（2）低于2.5L·min⁻¹·m⁻²的心脏指数时间加权平均值（TWA）与高于0.3的COx的TWA之间的相关性，以及（3）不同亚组中心脏指数曲线与COx曲线之间的面积差异。
最终分析纳入了155例患者。心脏指数中位数为3.16[四分位间距（IQR）：2.65，3.72]L·min⁻¹·m⁻²。COx中位数为0.23[IQR：0.12，0.34]。（1）心脏指数与COx之间的互相关中位数为0.230[IQR：0.186，0.287]。（2）低于2.5L·min⁻¹·m⁻²的心脏指数TWA与高于0.3的COx的TWA之间的相关性（Spearman ρ）为0.095（P = 0.239）。（3）心脏指数曲线与COx曲线之间的面积在各亚组之间无显著差异（<65岁与≥65岁，P = 0.903；0个与≥1个心血管危险因素，P = 0.518；动脉高血压与无动脉高血压，P = 0.822；开放手术与机器人辅助根治性前列腺切除术，P = 0.699）。
我们发现术中心脏指数的波动与CA之间无有意义的关联。然而，麻醉对CA的影响可能掩盖了潜在的关联。
