体外循环术中局部脑氧饱和度与术后谵妄的关系

The Clinical Study on Relation between Regional Cerebral Oxygen Saturation and Postoperative Delirium in Patients during Cardiopulmonary Bypass

目的探讨体外循环(CPB)心血管外科手术期间患者脑氧代谢与术后谵妄的关系。方法收集择期行CPB下心内直视手术患者28例,术后7 d内,每日以ICU精神错乱评估量表(CAM-ICU)评估患者的精神状态,以是否发生谵妄分为谵妄组和非谵妄组。2组术中均以近红外光谱仪动态监测监测局部脑氧饱和度(rScO2),计算围手术期中7个时段(术前、诱导前、诱导至CPB前、CPB开始至鼻咽温降温末、鼻咽温降温末至复温初、复温初至CPB结束、CPB结束后30 min)rScO2均值;计算rScO2曲线下面积(AUC-rScO2)。结果谵妄组AUC-rScO2较非谵妄组增大(P<0.05)。结论心血管外科手术CPB期间患者出现低rScO2,使术后谵妄的发生率增加,故术中应持续监测rScO2。

Objective To study the relation between regional cerebral oxygen saturation（rScO2） and postoperative delirium in patients underwent cardiopulmonary bypass（CPB） of cardiac surgery.Methods Twenty-eight patients underwent elective cardiac surgery were enrolled in the study.Postoperative delirium was assessed by the CAM-ICU everyday during 7 days after operation.All of the patients were divided into two groups（delirium group and non-delirium group） based on the postoperative delirium.The rScO2 of all patients was monitored during operation.The value of the mean rScO2 in the 7 periods（preoperatiion,preinducement,from inducement to the beginning of CPB,from the beginning of CPB to the end of nose temperature cooling,from the end of nose temperature cooling to the beginning of warming,from the beginning of warming to the end of CPB,the 30 minutes after CPB） during the operation period were calculated.The area under the curve of the rScO2 was calculated.Results The AUC-rScO2 of the patients in delirium group was significantly larger than the non-delirium group（P〈0.05）.Conclusions The low rScO2 increases the postoperative delirium in patients who underwent cardiopulmonary bypass of cardiac surgery.Hence we should monitor the rScO2 during operation.