Moller J T, Svennild I, Johannessen N W, Jensen P F, Espersen K, Gravenstein J S, Cooper J B, Djernes M, Johansen S H
Department of Anaesthesia, Herlev Hospital, University of Copenhagen, Denmark.
Br J Anaesth. 1993 Sep;71(3):340-7. doi: 10.1093/bja/71.3.340.
In a randomized, blinded clinical study, we have used objective and subjective measures to determine if perioperative monitoring with pulse oximetry--by virtue of its potential to lessen hypoxaemia--would decrease late postoperative cognitive dysfunction. We investigated 736 adult patients undergoing elective procedures (other than cardiac, neurosurgical or for cancer) under regional or general anaesthesia, allocated randomly to undergo (group I) or not to undergo (group II) pulse oximetry monitoring in the operating theatre and recovery room. Cognitive function was evaluated using the Wechsler memory scale (WMS) and continuous reaction time (RT) test the day before surgery, and on the 7th day after operation or at discharge if that occurred before postoperative day 7. A questionnaire sent 6 weeks after surgery elicited patients' subjective perceptions regarding cognitive abilities. There were no significant differences between the two groups in either the total WMS score, the score for each WMS subtests or RT test. The questionnaire revealed that 7% in group I and 11% in group II believed cognitive abilities had decreased (ns). For the 40 patients whose WMS scores were 10 points less after than before operation, a follow-up study was undertaken 3 months after surgery. At that time, the median WMS score had returned to the preoperative value. We conclude that, for these 736 patients, subjective and objective measures did not indicate less postoperative cognitive impairment after perioperative monitoring with pulse oximetry.
在一项随机、双盲临床研究中，我们采用客观和主观测量方法来确定围手术期使用脉搏血氧饱和度仪进行监测——鉴于其减轻低氧血症的可能性——是否会减少术后晚期认知功能障碍。我们调查了736例接受择期手术（非心脏、神经外科或癌症手术）的成年患者，这些患者在区域麻醉或全身麻醉下随机分为两组，一组（I组）在手术室和恢复室接受脉搏血氧饱和度监测，另一组（II组）不接受监测。在手术前一天、术后第7天或如果在术后第7天之前出院则在出院时，使用韦氏记忆量表（WMS）和连续反应时间（RT）测试对认知功能进行评估。术后6周发送的一份问卷收集了患者对认知能力的主观感受。两组在WMS总分、每个WMS子测试得分或RT测试方面均无显著差异。问卷显示，I组7%的患者和II组11%的患者认为认知能力下降（无显著性差异）。对于40例术后WMS评分比术前低10分的患者，在术后3个月进行了随访研究。当时，WMS评分中位数已恢复到术前值。我们得出结论，对于这736例患者，主观和客观测量均未表明围手术期使用脉搏血氧饱和度监测后术后认知损害减轻。
