术后精神错乱——与术后低氧血症的关联

Postoperative mental confusion--association with postoperative hypoxemia.

作者信息

Rosenberg J, Kehlet H

机构信息

Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark.

出版信息

Surgery. 1993 Jul;114(1):76-81.

PMID:8356531

Abstract

BACKGROUND

Postoperative confusion is a well-known complication, but the pathogenetic mechanisms, of which hypoxemia may be one, are not completely understood.

METHODS

Thirty otherwise healthy patients undergoing major abdominal surgery and ten patients undergoing middle ear minor surgery, all under general anesthesia, were monitored for oxygen saturation (SpO2) with a pulse oximeter on a preoperative night and on the second night after operation (11:00 PM to 7:00 AM). All patients were tested with a mental test questionnaire (the Hodkinson modification of the original Roth-Hopkins test) before operation and on the third and seventh day after operation.

RESULTS

Postoperative hypoxemia did not develop in patients undergoing minor surgery, whereas major surgery was associated with severe constant and episodic hypoxemia on the second postoperative night (p < 0.05). The patients undergoing major surgery had decreased mental function on the third day (p < 0.05) but not on the seventh day after operation, whereas minor surgery did not impair mental function. There was a significant correlation between mental function on the third day after operation and mean SpO2 on the second postoperative night after major surgery (rs = 0.53, p < 0.005) and minor surgery (rs = 0.74, p < 0.03). After major surgery there was also a correlation between decrease (preoperative to postoperative) in mental function on the third postoperative day and mean SpO2 on the second postoperative night (rs = -0.40, p < 0.04). During stepwise multiple regression analysis in patients undergoing major surgery, a significant relationship was found between postoperative mental test score and SpO2 (p < 0.05) but not between mental function and other perioperative variables (age, premedication dose, duration of operation, and intraoperative and postoperative opioid dose).

CONCLUSIONS

These results suggest postoperative hypoxemia to be an important pathogenetic factor in postoperative mental dysfunction.

摘要

背景

术后谵妄是一种众所周知的并发症，但其发病机制尚未完全明确，低氧血症可能是其中之一。

方法

30例接受腹部大手术的健康患者和10例接受中耳小手术的患者，均在全身麻醉下，于术前一晚及术后第二晚（晚上11点至次日早上7点）使用脉搏血氧仪监测血氧饱和度（SpO2）。所有患者在术前、术后第三天和第七天接受心理测试问卷（对原始Roth-Hopkins测试的霍金森改良版）测试。

结果

接受小手术的患者未发生术后低氧血症，而腹部大手术患者在术后第二晚出现严重持续性和间歇性低氧血症（p<0.05）。接受大手术的患者在术后第三天精神功能下降（p<0.05），但术后第七天未下降，而小手术未损害精神功能。大手术和小手术后第三天的精神功能与术后第二晚的平均SpO2之间存在显著相关性（大手术：rs = 0.53，p<0.005；小手术：rs = 0.74，p<0.03）。大手术后，术后第三天精神功能（术前至术后）的下降与术后第二晚的平均SpO2之间也存在相关性（rs = -0.40，p<0.04）。在对接受大手术的患者进行逐步多元回归分析时，发现术后心理测试评分与SpO2之间存在显著关系（p<0.05），但精神功能与其他围手术期变量（年龄、术前用药剂量、手术持续时间以及术中及术后阿片类药物剂量）之间无显著关系。