组织氧饱和度与单肺通气患者术后认知功能障碍的关联

The correlation between tissue oxygen saturation and postoperative cognitive dysfunction in elderly patients with one lung ventilation

目的探讨胸科手术单肺通气时组织氧饱和度变化与术后神经认知障碍(PND)的关系。方法收集2017年8月至2018年9月在河北医科大学第四医院接受择期肺叶切除术的老年患者128例,根据术后3 d是否发生PND将患者分为PND组(n=34)和非PND组(n=94)。采用组织氧饱和度仪监测双侧前脑组织氧饱和度(SctO2)、前臂肱桡肌和股四头肌的肌肉组织氧饱和度(SmtO2)。术前及术后3 d分别采用蒙特利尔认知评估量表(MoCA)评估患者认知功能。若患者术后MoCA评分较术前下降≥2分即被认为发生了PND。观察指标为PND发生率、术后并发症发生率及住院时间。采用logistic回归分析PND的独立危险因素。结果本研究PND发生率为26.6%(34/128)。2组患者在非神经系统并发症(新发心律失常、肺部感染、肺栓塞、急性肾功能不全、败血症、深静脉血栓)方面,差异均无统计学意义(均P>0.05)。PND组患者术后住院时间为7.0(6.0,8.5)d,较非PND组的6.0(5.0,8.0)d延长,差异有统计学意义(U=2.394,P=0.017)。上肢SmtO2最低值(OR=0.988,95%CI:0.954~1.024,P=0.519)、降幅(OR=1.010,95%CI:0.979~1.042,P=0.514)和下肢SmtO2最低值(OR=0.996,95%CI:0.961~1.032,P=0.832)、降幅(OR=0.997,95%CI:0.971~1.025,P=0.851)均与PND无相关性。多因素logistic回归分析显示,美国麻醉医师协会(ASA)分级高(OR=2.617,95%CI:1.112~6.157,P=0.029)和单肺通气期间SctO2最低值(OR=0.931,95%CI:0.880~0.986,P=0.014)是发生PND的危险因素。结论SctO2降低是接受择期肺叶切除术老年患者发生PND的危险因素之一,而SmtO2变化与PND无相关性。

Objective To investigate the correlation between tissue oxygen saturation during one lung ventilation and postoperative neuro cognitive dysfunction(PND)in elderly patients in thoracic surgery.Methods One hundred and twenty-eight elderly patients who underwent selective lobectomy from August 2017 to September 2018 in the Forth Hospital of Hebei Medical University were enrolled.The patients were divided into PND group(n=34)and non-PND group(n=94)according to whether PND occurred 3 days after surgery.Tissue oxygenation was monitored at bilateral forebrain,brachioradialis muscle and quadriceps.Cognitive function was assessed by the Montreal Cognitive Assessment(MoCA)at baseline and the third day after the operation.Postoperative cognitive dysfunction was diagnosed if postoperative MoCA decreased at least 2 scores compared with preoperative baseline value.Outcomes included the incidence of PND,the incidence of tissue oxygen desaturation during one lung ventilation,postoperative complications within 30 days and length of postoperative in-hospital stay.Logistic regression was used to screen independent risk factors of PND.Results The incidence of postoperative cognitive dysfunction was 26.6%(34/128).The two groups had no significant difference in the incidence of non-neurogenic complications(new occurred arrhythmia,pulmonary infection,pulmonary embolism,acute renal insufficiency,sepsis,deep vein thrombosis,all P>0.05).However,the length of postoperative in-hospital stay of PND group was 7.0(6.0,8.5)d,which was longer than that of non-PND group[6.0(5.0,8.0)d].There was significant difference(U=2.394,P=0.017).There was no correlation between the two groups within the minimum of SmtO2 in upper limbs(OR=0.988,95%CI:0.954-1.024,P=0.519)and the range of desaturation(OR=1.010,95%CI:0.979-1.042,P=0.514),as well as the minimum of SmtO2 in legs(OR=0.996,95%CI:0.961-1.032,P=0.832)and the range of desaturation(OR=0.997,95%CI:0.971-1.025,P=0.851).Multivariate logistic regression analysis showed that the high ASA grade(OR=2.617,95%CI:1.112-6.157,P=0.029)and the minimum of cerebral oxygen saturation during one lung ventilation(OR=0.931,95%CI:0.880-0.986,P=0.014)were independent risk factors of PND.There was no statistical correlation between muscle oxygen saturation and PND.Conclusion Cerebral desaturation during one lung ventilation increased the risk of PND in elderly patients,while the muscle desaturation has no statistical correlation with PND.