术中脑氧饱和度干预对老年脊柱结核手术患者术后谵妄的影响

Effect of interventional intraoperative cerebral oxygen saturation monitoring on postoperative delirium in elderly patients with spinal tuberculosis

目的对老年脊柱结核手术患者术中脑氧饱和度(regional oxygen saturation monitoring,rSO2)进行监测,探讨术中rSO2与术后谵妄(postoperative delirium,POD)的关系。方法选取杭州市红十字会医院2017年1月-2017年12月老年胸腰椎脊柱结核手术患者60例,根据是否发生POD分为POD组(13例)和非POD组(47例)。另取2018年1月-2018年12月老年胸腰椎脊柱结核手术患者60例,根据随机数字法分为干预组和非干预组,每组30例。采用修订的谵妄评估量表评估POD,干预组患者根据术中rSO2值调整脑灌注量使左脑rSO2不低于术前值的20%。监测患者术前和术中左脑和右脑rSO2值。结果术前,2组左脑rSO2、右脑rSO2比较差异无统计学意义(P>0.05);术中POD组左脑rSO2下降20%的比例(46.15%)高于非POD组(χ2=5.863,P<0.05),2组右脑rSO2下降20%的比例差异无统计学意义(P>0.05)。术前2组左脑rSO2、右脑rSO2比较差异无统计学意义(均P>0.05);术中,干预组左脑最低rSO2[(68.08±6.68)%]高于非干预组(t=17.597,P<0.05),2组右脑最低rSO2差异无统计学意义(P>0.05);POD发生率(3.33%)低于非干预组(χ2=6.405,P<0.05)。结论老年脊柱结核手术患者术中rSO2与术后POD发生有关,干预术中rSO2可有效降低术后POD的发生。

Objective Intraoperative cerebral regional oxygen saturation monitoring(rSO2) was monitored in elderly patients with spinal tuberculosis surgery in order to investigate the relationship between intraoperative rSO2 and postoperative delirium(POD). Methods Sixty patients with thoracolumbar spine tuberculosis surgery from January to December 2017 in Hangzhou Red Cross Hospital were selected, and divided into POD group(13 patients) and non-POD group(47 patients) according to whether or not POD occurred. Sixty patients with elderly thoracolumbar spine tuberculosis from July to December 2018 were selected, and divided into intervention group and non-intervention group accorded to the random number method with 30 cases in each group. The delirium evaluation scale was used for evaluation of POD. In the intervention group, the cerebral perfusion was adjusted according to the intraoperative rSO2 value to make the left brain rSO2 not lower than 20% of the preoperative value. The preoperative and intraoperative left and right brain rSO2 values were monitored. Results There were no significant differences in the values of left and right brain rSO2 between the two groups before surgery(P>0.05). During the operation, the proportion of left brain rSO2 decreased by 20% in the POD group(38.46%) was higher than that in the non-POD group(χ2=5.863, P<0.05). There was no significant difference in the proportion of rSO2 in the right brain between the two groups(P>0.05). There were no significant differences in the values of left and right brain rSO2 scores between the two groups before surgery(all P>0.05). During operation, the lowest rSO2 in the left brain of the intervention group [(68.08±6.68) %] was higher than that in the non-intervention group(t=17.597, P<0.05). There were no significant difference in the lowest rSO2 between the two groups(P>0.05). The incidence of POD(3.33%) was lower than that of the non-intervention group(χ2=6.405, P<0.05). Conclusion Intraoperative rSO2 is associated with postoperative POD in elderly patients with spinal tuberculosis. Intervention of rSO2 can effectively reduce postoperative POD.