术中脑氧饱和度监测对老年手术患者术后谵妄的预测价值

Application of regional cerebral oxygen saturation monitoring in predicting postoperative delirium in elderly patients

目的探讨术中脑氧饱和度(regional cerebral oxygen saturation,rSO2)监测对老年手术患者术后谵妄(postoperative delirium,POD)的预测价值.方法选择拟行手术治疗的140例老年患者,所有患者于入室吸氧后清醒状态(t0)、麻醉诱导双肺通气时(t1)、侧卧位双肺通气时(t2)、侧卧位单肺通气稳定时(t3)、拔管后清醒时(t4)监测rSO2及MAP、心率、SpO2、PETCO2,记录患者rSO2基础值、rSO2最低值(minimum rSO2,rSO2min)、术中rSO2平均值(mean rSO2,rSO2mean)、rSO2较基础值下降的最大百分数(maximum percentage drop in rSO2,rSO2%max).术后按照POD诊断标准分为POD组(24例)和非POD组(116例).Logistic回归分析发生POD的独立危险因素,受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评价rSO2对POD发生的预测价值.结果140例老年患者术后24例发生POD,发生率为17.1%.t3时POD组rSO2值明显低于非POD组,差异有统计学意义(P<0.05);两组其余各时点rSO2值比较差异无统计学意义(P>0.05).POD组和非POD组患者各时间点MAP、心率、SpO2、PETCO2值比较差异无统计学意义(P>0.05);POD组年龄、rSO2%max明显高于非POD组,rSO2min、rSO2mean明显低于非POD组,差异有统计学意义(P<0.05).Logistic多因素分析显示年龄、rSO2%max是影响POD的独立危险因素(P<0.05).rSO2%max临界值为15.59%时,预测POD的曲线下面积为0.893(95%CI 0.829~0.939),特异度和灵敏度分别为79.31%和91.67%.结论rSO2%max是老年手术患者术后发生POD的独立危险因素,rSO2%max>15.59%可以作为预测POD发生的指标.

Objective To evaluate the application of regional cerebral oxygen saturation(rSO2)in predicting postoperative delirium(POD)in elderly patients.Methods A total of 140 elderly patients were enrolled in this study.The value of rSO2,mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO2)and end-tidal carbon dioxide partial pressure(PETCO2)were monitored at the time of room entry(t0),double-lung ventilation during anesthesia induction(t1),double-lung ventilation during lateral position(t2),single-lung ventilation during lateral position(t3),and extubation after surgery(t4).Meanwhile,the baseline of rSO2,minimum rSO2(rSO2min),mean rSO2(rSO2mean)and maximum percentage drop in rSO2(rSO2%max)were recorded.The patients were divided into a POD group(n=24)and a non-POD group(n=116),according to the definition of POD.The independent risk factors of POD were determined using multivariate Logistic regression,and receiver operating characteristic curve(ROC)analysis was performed to assess the accuracy of rSO2 in predicting POD.Results POD was present in 24 patients among 140 elderly patients(17.1%).At t3 point,the levels of rSO2 were significantly decreased in the POD group compared with the non-POD group(P<0.05).However,no significant differences were found in rSO2 value between other time points.In addition,there were no differences among MAP,heart rate,SpO2,PETCO2 between the two groups(P>0.05).In the POD group,its age and rSO2%max were significantly higher than that in the non-POD group,while its rSO2min and rSO2mean were significantly lower than that in the non-POD group(P<0.05).Logistic regression analysis showed that,age and rSO2%max were the independent risk factors for POD.ROC curve showed that the area under receiver operating characteristic curve(AUC)of rSO2%max was 0.893(95%CI 0.829-0.939)at a cutoff value of 15.59%.The specificity and sensitivity of rSO2%max in predicting POD were 79.31%and 91.67%,respectively.Conclusions rSO2%max is the independent risk factor for POD in elderly patients after surgery,and rSO2%max>15.59%is considered a potential predictor of POD.