老年心脏手术患者术后精神分裂与脑氧饱和度降低的关系

Association Between Postoperative Delirium and Postoperative Cerebral Oxygen Desaturation in Older Patients After Cardiac Surgery

练成杏仁核氨一般而言减低与消化系统并发症相关。我们使用近红外光谱非前列腺癌地量度角化大脑氨一般而言。本次数据分析观察了肺部手练成后老年病征围练成期脑氨一般而言减低有否与练成后消化系统并发症相关。

在2015年至2017年期间，我们将70岁及以上计划进行肺部手练成的病征归属于一项单中心、实用价值、观察病态数据分析。练成前一天量度所有病征脑氨一般而言基础值。在练成中及ICU连续系统对病征脑氨一般而言至练成后72h。使用ICU病征意识模糊风险评估单（Confusion assessment method for the ICU，CAM-ICU）风险评估癫痫，采用非校正分析和多数组Logistic回归分析高度评价其与癫痫的差异病态。

一合共103例病征被归属于这项实用价值观察病态数据分析，剔除不满足条件的病征后最终合共96例病征被归属于数据分析，其中29例（30%）病征出现练成后癫痫。练成杏仁核氨一般而言减低与练成后癫痫无显著差异病态。与无癫痫病征相比，癫痫病征练成后最低脑氨一般而言极低，且癫痫病征练成后脑氨一般而言的绝对值相对急剧下降更显著;排除脑氨一般而言考量后，病征间其它差异不显著。时年、中风史、较高的EuroSCORE II评分、练成前MMSE评分极低、练成后较显著的脑氨一般而言绝对值减低均与练成后癫痫的发生独立相关。

给予体外循环肺部手练成的老年病征练成后癫痫与脑氨一般而言减低有关，尤其在癫痫猝死后平庸更为显著。

Eertmans W,De Deyne C,Genbrugge C,et al.Association Between Postoperative Delirium and Postoperative Cerebral Oxygen Desaturation in Older Patients After Cardiac Surgery. Br J Anaesth 2020; 124 (2): 146-153.

Background: Near-infrared spectroscopy non-invasively measures regional cerebral oxygen saturation. Intraoperative cerebral desaturations he been associated with worse neurological outcomes. We investigated whether perioperative cerebral desaturations are associated with postoperative delirium in older patients after cardiac surgery.Methods: Patients aged 70 yr and older scheduled for on-pump cardiac surgery were included between 2015 and 2017 in a single-centre, prospective, observational study. Baseline cerebral oxygen saturation was measured 1 day before surgery.Throughout surgery and after ICU admission, cerebral oxygen saturation was monitored continuously up to 72 h after operation. The presence of delirium was assessed using the confusion assessment method for the ICU. Association with delirium was evaluated with unadjusted yses and multivariable logistic regression.Results: Ninety-six of 103 patients were included, and 29 (30%) became delirious. Intraoperative cerebral oxygen saturation was not significantly associated with postoperative delirium. The lowest postoperative cerebral oxygen saturation was lower in patients who became delirious (P¼0.001). The absolute and relative postoperative cerebral oxygen saturation decreases were more marked in patients with delirium (13 [6]% and 19 [9]%, respectively) compared with patients without delirium (9 [4]% and 14 [5]%; P¼0.002 and P¼0.001, respectively). These differences in cerebral oxygen saturation were no longer present after excluding cerebral oxygen saturation values after patients became delirious. Older age,previous stroke, higher EuroSCORE II, lower preoperative Mini-Mental Status Examination, and more substantial absolute postoperative cerebral oxygen saturation decreases were independently associated with postoperative delirium incidence.Conclusions: Postoperative delirium in older patients undergoing cardiac surgery is associated with absolute decreases in postoperative cerebral oxygen saturation. These differences appear most detectable after the onset of delirium.