Wang Lei, Wang Zhen Hong, Zhu Duan Qi, Xie Xin Yi, Chen Xin, Wang Xiao Liang
Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
J Cardiothorac Surg. 2025 Jan 6;20(1):32. doi: 10.1186/s13019-024-03300-x.
This study aims to investigate the clinical application value of the central venous-arterial carbon dioxide partial pressure difference (Pv-aCO2) in postoperative cognitive dysfunction(POCD) in patients with acute aortic dissection.
A retrospective analysis was conducted on the general data of 236 patients. Blood gas samples were collected from the arterial and venous lines at various time points during the surgery, including before and after the initiation of cardiopulmonary bypass (CPB), immediately after CPB initiation, before and after deep hypothermic circulatory arrest, 30 min after rewarming, and 5 min before weaning from CPB. The partial PV-aCO2 was calculated. Based on the average PV-aCO2 value, patients were divided into an observation group (PV-aCO2 > 6 mmHg, n = 112) and a control group (PV-aCO2 < 6 mmHg, n = 124). The perioperative data and Mini-Mental State Examination (MMSE) scores were compared between the two groups to assess the incidence and severity of POCD. Additionally, the expression levels of peripheral serum S100β in the two groups were compared 6 h postoperatively.
The incidence of POCD was higher in the observation group compared to the control group, while MMSE scores and serum S100β levels were lower in the observation group. Additionally, the observation group patients with POCD had lower MMSE scores and serum S100β levels compared to the control group patients. In addition, logistic regression analysis revealed that advanced age, serum S100β levels, female gender, CPB time, unilateral brain perfusion time, hyperlipidemia, diabetes, and smoking history were all independent risk factors for postoperative POCD (all P < 0.05).
Pv-aCO2 can effectively reflect the intraoperative cerebral metabolic level in patients with acute aortic dissection and can serve as an intraoperative warning indicator for cognitive dysfunction. Its clinical recommendation for use is warranted.
本研究旨在探讨中心静脉 - 动脉二氧化碳分压差值（Pv - aCO2）在急性主动脉夹层患者术后认知功能障碍（POCD）中的临床应用价值。
对236例患者的一般资料进行回顾性分析。在手术过程中的各个时间点从动脉和静脉管路采集血气样本，包括体外循环（CPB）开始前和后、CPB开始后即刻、深低温停循环前后、复温后30分钟以及CPB撤机前5分钟。计算Pv - aCO2。根据Pv - aCO2平均值，将患者分为观察组（Pv - aCO2 > 6 mmHg，n = 112）和对照组（Pv - aCO2 < 6 mmHg，n = 124）。比较两组围手术期数据和简易精神状态检查表（MMSE）评分，以评估POCD的发生率和严重程度。此外，术后6小时比较两组外周血清S100β的表达水平。
观察组POCD发生率高于对照组，而观察组的MMSE评分和血清S100β水平较低。此外，观察组发生POCD的患者与对照组患者相比，MMSE评分和血清S100β水平更低。另外，逻辑回归分析显示，高龄、血清S100β水平、女性、CPB时间、单侧脑灌注时间、高脂血症、糖尿病和吸烟史均为术后POCD的独立危险因素（均P < 0.05）。
Pv - aCO2可有效反映急性主动脉夹层患者术中脑代谢水平，可作为认知功能障碍的术中预警指标。值得进行临床应用推荐。
