术中局部脑氧饱和度水平与老年全身麻醉术后谵妄发生的关系

目的探讨术中局部脑氧饱和度(rSO2)的变化与老年患者全麻手术后发生谵妄的关系。方法选择2017年1月至2018年1月内蒙古医科大学附属医院麻醉科收治的老年全麻脊柱手术患者76例。患者入室后持续监测rSO2,并记录麻醉诱导前(T0)、气管插管后(T1)、手术开始时(T2)、手术开始后1 h(T3)、手术开始后2 h(T4)、术毕(T5)时的rSO2、心率(HR)及平均动脉压(MAP)。以患者T0时的rSO2值作为基线值,计算T0~T5的rSO2平均值(rSO2)、最小值(rSO2min)和较基线值下降的最大差值(ΔrSO2max)。采用意识紊乱测试法(CAM)对术后患者认知状态进行评估,并分为术后谵妄组(POD组,14例)和非术后谵妄组(NPOD组,62例),同时比较2组上述指标。采用SPSS 18.0软件对数据进行分析。组间比较采用t检验,组内比较采用重复测量的方差分析或两两比较。结果POD发生率为18.4%(14/76)。2组患者T0~T5的MAP及HR比较差异均无统计学意义(P>0.05)。T0~T3的rSO2在2组间比较无明显差异(P>0.05);T4、T5时,相比NPOD组,POD组患者rSO2值明显下降(P<0.05)。与NPOD组比较,POD组患者ΔrSO2max显著升高(0.09±0.04)%和(0.05±0.02)%],rSO2显著降低(73.29±1.69)%和(75.49±1.89)%],但rSO2min(65.00±3.40)%和(67.47±5.10)%]及基线值(71.14±0.77)%和(70.95±0.89)%]比较差异无统计学意义(P>0.05)。结论术中rSO2的降低与POD的发生有明显相关性,术中监测rSO2可作为预测POD发生的辅助手段。

Relationship between intraoperative level of cerebral oxygen saturation and postoperative delirium in the elderly undergoing general anesthesia during surgery

Objective To investigate the relationship between the changes of regional cerebral oxygen saturation(rSO2)and postoperative delirium in the elderly after general anesthesia.Methods A total of 76 elderly patients receiving spinal surgery under general anesthesia in our hospital from January 2017 to January 2018 were enrolled in this study.After entering the operation room,the patients were monitored for rSO2 continuously.rSO2,heart rate(HR)and mean arterial pressure(MAP)were recorded before anesthesia induction(T0),after tracheal intubation(T1),at the beginning of(T2),in 1 h(T3)and 3 h(T4)after,and at the end of operation(T5).With the rSO2 value at T0 as the baseline value,the mean(rSO2),minimum(rSO2min)and maximum descendence(ΔrSO2max)of rSO2 from T0 to T5 were calculated.Consciousness disorder test(CAM)was applied for the cognitive status of postoperative patients,and they were divided into postoperative delirium group(POD group,n=14)and non-postoperative delirium group(NPOD group,n=62).SPSS statistics 18.0 was used to analyze the data.t test,the analysis of variance of repeated measurement or pairwise comparison was employed for comparison.Results The incidence of POD was 18.4%(14/76)in this study.There were no significant differences in MAP and HR at T0 to T5 between the 2 groups(P>0.05).Though no obvious differences were seen in rSO2 at T0-T3 between the 2 groups(P>0.05),the value was significantly decreased in the POD group than the NPOD group at T4 and T5(P<0.05).The POD group had significantly higherΔrSO2max(0.09±0.04)%vs(0.05±0.02)%],and lower rSO2(73.29±1.69)%vs(75.49±1.89)%],but no obviously difference in rSO2min(65.00±3.40)%vs(67.47±5.10)%,P>0.05]and baseline(71.14±0.77)%vs(70.95±0.89)%,P>0.05]when compared with the NPOD group.Conclusion There is a significant correlation between the decrease of intraoperative rSO2 and occurrence of POD.The monitoring of rSO2 during operation can be used as an auxiliary means to predict the occurrence.