Claesson-Lingehall Helena, Olofsson Birgitta, Gustafson Yngve, Wahba Alexander, Appelblad Micael, Svenmarker Staffan
Department of Nursing, Umeå University, Umeå, SE, 901 87, Sweden.
Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
BMC Anesthesiol. 2025 May 26;25(1):267. doi: 10.1186/s12871-025-03141-8.
Delirium is a common neurological complication after cardiac surgery. The purpose of the present study was to analyze the association between hemodynamic fluctuations during cardiopulmonary bypass (CPB) and the incidence of postoperative delirium (POD) in patients undergoing cardiac surgery with CPB.
This post hoc analysis included one-hundred-ninety-five (n = 195) patients aged ≥ 65 years of whom seventy (n = 70) patients developed POD. Intraoperative hemodynamic variables specifically related to the conduct of CPB were digitally recorded at 1-minute intervals. Variables outside the presumed safe boundaries for mean arterial pressure (MAP), systemic perfusion flow index- L/min/BSA (QBSA), systemic venous oxygen saturation (SO) and arterial oxygen delivery- ml/min/BSA (DO) were defined and analyzed with reference to indices of area under the curve (AUC) and the relative proportion of registrations related to POD. POD was diagnosed according to DSM-5 criteria based on a test battery performed preoperatively and repeated twice postoperatively. Statistical tests used to verify observations outside the predefined norm included the Mann-Whitney U test and the chi-squared test.
Markers of hemodynamic control during CPB showed significant associations with POD. Both DO (P = 0.02) and QBSA (P < 0.001) identified POD patients outside the predefined upper and lower safety limits. SO values > 84% (P < 0.001) werealso associated with the development of POD. The number of SO registrations below the lower safety limit was negligible, why statistical analysis seemed not useful. No association between MAP and POD registrations was identified.
This study revealed a clear association between markers of hemodynamic control and POD. These associations were most pronounced for DO and QBSA. The detected association between high SO and POD warrants further insight.
谵妄是心脏手术后常见的神经系统并发症。本研究的目的是分析体外循环（CPB）期间血流动力学波动与接受CPB心脏手术患者术后谵妄（POD）发生率之间的关联。
这项事后分析纳入了195例年龄≥65岁的患者，其中70例发生了POD。与CPB操作具体相关的术中血流动力学变量以1分钟的间隔进行数字记录。定义并分析平均动脉压（MAP）、全身灌注流量指数-L/min/体表面积（QBSA）、全身静脉血氧饱和度（SO）和动脉氧输送-ml/min/体表面积（DO）超出假定安全边界的变量，并参考曲线下面积（AUC）指标以及与POD相关的记录相对比例进行分析。根据DSM-5标准，通过术前进行的一组测试并在术后重复两次来诊断POD。用于验证超出预定义标准的观察结果的统计检验包括Mann-Whitney U检验和卡方检验。
CPB期间血流动力学控制指标与POD显著相关。DO（P = 0.02）和QBSA（P < 0.001）均识别出超出预定义上下安全限的POD患者。SO值> 84%（P < 0.001）也与POD的发生相关。低于下限安全限的SO记录数量可忽略不计，因此统计分析似乎无用。未发现MAP与POD记录之间存在关联。
本研究揭示了血流动力学控制指标与POD之间存在明显关联。这些关联在DO和QBSA方面最为明显。检测到的高SO与POD之间的关联值得进一步深入研究。
