心脏手术患者术中脑组织氧饱和度和神经损伤标志物与术后谵妄的关联性研究

目的 探讨心脏手术患者术中脑组织氧饱和度(rScO2)和神经损伤标志物与术后谵妄(POD)的关联性.方法 选择2020年1月至2021年6月于河南省胸科医院行体外循环(CPB)下心脏瓣膜置换手术患者60例,剔除3例,根据患者术后3 d内发生POD情况将其分为POD组(15例)和非POD组(NPOD组,42例).术中应用...

A study on the correlation of intraoperative regional cerebral oxygen saturation and nerve injury markers with postoperative delirium in patients undergoing heart surgery

Objective To explore the correlation of intraoperative regional cerebral oxygen saturation(rScO₂)and nerve injury markers with postoperative delirium(POD)in patients undergoing heart surgery.Methods Sixty patients undergoing heart valve replacement surgery under cardiopulmonary bypass(CPB)in Henan Provincial Chest Hospital from January 2020 to June 2021 were selected,and 3 of them were excluded.The patients were divided into POD group(15 cases)and non-POD group(NPOD group,42 cases)according to the occurrence of POD within 3 days after operation.During the operation,a near-infrared spectrometer was used to continuously monitor the patients′rScO₂ and pulse oximetry(SpO₂).The difference in artery-rScO₂(da-rScO₂)was calculated.The patients′central venous blood was drawn to determine the serum levels of nerve injury marker S100βprotein and neuron-specific enolase(NSE)10 minutes(min)before induction of anesthesia(T₀),10 min after induction of anesthesia(T₁),immediately after CPB(T₂),at the end of CPB(T₃),after operation(T₄),when the patients were admitted to the intensive care unit(ICU)(T₅),and 1 day(T₆),2 days(T₇)and 3 days(T₈)after operation,respectively,using enzyme-linked immunosorbent assay(ELISA)method.The above observation data were compared between the two groups,and the correlation between these observation data and the occurrence of POD was analyzed.Results There were no significant differences between the two groups in age,weight,height,gender,etiology,comorbidities,history of smoking,history of drinking,as well as basic blood oxygen saturation and baseline value of rScO₂(P>0.05).Compared with the NPOD group,the POD group had longer aortic occlusion time,shorter cerebral perfusion time and CPB time,but the differences were not statistically significant(P>0.05).The duration of intraoperative reduction of rScO₂>25%in the POD group was significantly longer than that in the NPOD group(P<0.05).During CPB,the minimum mean arterial pressure and the minimum rScO₂ in the POD group were lower than those in the NPOD group,while the maximum da-rScO₂ and the duration of da-rScO₂>50%,the duration of da-rScO₂>40%,the duration of rScO₂<50%and the duration of rScO₂<40%in the POD group were significantly greater than those in the NPOD group,and the differences were statistically significant(P<0.05).From T₀ to T₈,the levels of serum nerve injury markers S100βand NSE in the two groups showed an upward trend,and the increase in the POD group was greater.From T₂ to T₈ time points,the levels of serum S100βand NSE in the POD group were higher than those in the NPOD group,and the differences were statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that the longer duration of rScO₂ reduction>25%,the duration of rScO₂<40%and the duration of da-rScO₂>50%during CPB,and higher levels of serum S100βand NSE were the risk factors promoting the occurrence of POD(P<0.05).Conclusion During CPB,longer duration of rScO₂ reduction>25%,duration of rScO₂<40%,and duration of da-rScO₂>50%are risk factors for promoting the occurrence of POD in patients undergoing heart surgery under CPB,and the elevated levels of nerve injury markers S100βand NSE are also associated with the occurrence of POD.