Qiu Lingqin, Ma Yabing, Ge Li, Zhou Haijiao, Jia Wenqin
Department of Anesthesiology, Gansu Provincial Hospital, Lanzhou, Gansu Province, China.
Department of Anesthesiology, Gansu Provincial Hospital, Lanzhou, Gansu Province, China.
World Neurosurg. 2025 Feb;194:123570. doi: 10.1016/j.wneu.2024.123570. Epub 2025 Jan 23.
Perioperative neurocognitive disorders are common perioperative complications associated with various poor outcomes. Regional cerebral oxygen saturation (rSO2) monitoring is a noninvasive technique based on near-infrared spectroscopy detection. Due to the considerable controversy among currently published studies on the application of intraoperative rSO2 monitoring in adult patients undergoing elective noncardiac surgery, this study aims to conduct a systematic review and meta-analysis to provide more comprehensive and robust evidence to support clinical decision-making.
This study conducted a systematic literature search of databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, from their inception to May 1, 2024. The eligible randomized controlled trials included adult patients undergoing elective noncardiac surgery under general anesthesia who received optimized anesthesia management guided by rSO2 monitoring and those in the control group who received routine anesthesia management under standard monitoring or blinded rSO2 monitoring. The primary outcomes were the incidence of perioperative neurocognitive disorders, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), and Mini-Mental State Examination (MMSE) scores. Secondary outcomes included the incidence of intraoperative cerebral desaturation and length of hospital stay (LOS).
The pooled results showed that compared to the control group, optimized anesthesia management guided by intraoperative rSO2 monitoring significantly reduced the incidence of POCD within 7 days postoperatively and may reduce the incidence of POCD at 3 months and longer periods postoperatively. However, it may not reduce the incidence of POD within 7 days or longer periods postoperatively, improve MMSE scores, reduce the incidence of intraoperative cerebral desaturation, or shorten LOS. Given the substantial heterogeneity in the pooled results for MMSE scores within 7 days postoperatively and LOS, and the limited number of studies reporting the incidence of POD, POCD, and MMSE scores after 7 days postoperatively, the related results should be interpreted with caution.
Despite the presence of heterogeneity and the inclusion of a limited number of studies for some outcomes, it is still recommended that clinical anesthesiologists routinely perform intraoperative rSO2 monitoring and optimize intraoperative anesthesia management based on the monitoring results to maximize rSO2 and improve cerebral perfusion, thereby improving patients' neurocognitive outcomes. Further large-scale, high-quality studies are needed to confirm the conclusions of this study.
围手术期神经认知障碍是常见的围手术期并发症，与多种不良结局相关。局部脑氧饱和度（rSO2）监测是一种基于近红外光谱检测的无创技术。由于目前已发表的关于术中rSO2监测在接受择期非心脏手术的成年患者中应用的研究存在相当大的争议，本研究旨在进行系统评价和荟萃分析，以提供更全面、有力的证据支持临床决策。
本研究对包括PubMed、Embase、Cochrane对照试验中心注册库和Web of Science在内的数据库进行了系统的文献检索，检索时间从各数据库建库至2024年5月1日。符合条件的随机对照试验包括在全身麻醉下接受择期非心脏手术的成年患者，其中一组接受基于rSO2监测的优化麻醉管理，另一组为对照组，接受标准监测或盲法rSO2监测下的常规麻醉管理。主要结局包括围手术期神经认知障碍的发生率，包括术后谵妄（POD）和术后认知功能障碍（POCD），以及简易精神状态检查表（MMSE）评分。次要结局包括术中脑氧饱和度降低的发生率和住院时间（LOS）。
汇总结果显示，与对照组相比，术中rSO2监测指导下的优化麻醉管理显著降低了术后7天内POCD的发生率，且可能降低术后3个月及更长时间POCD的发生率。然而，它可能不会降低术后7天内或更长时间POD的发生率，不会改善MMSE评分，不会降低术中脑氧饱和度降低的发生率，也不会缩短住院时间。鉴于术后7天内MMSE评分和住院时间的汇总结果存在显著异质性，且报告术后7天后POD、POCD和MMSE评分发生率的研究数量有限，相关结果应谨慎解读。
尽管存在异质性且部分结局纳入的研究数量有限，但仍建议临床麻醉医生常规进行术中rSO2监测，并根据监测结果优化术中麻醉管理，以使rSO2最大化并改善脑灌注，从而改善患者的神经认知结局。需要进一步开展大规模、高质量的研究来证实本研究的结论。
