局部脑氧饱和度目标导向管理对老年脊柱手术患者术后早期神经认知障碍的影响

Effects of goal-oriented management of cerebral oxygen saturation on early postoperative neurocognitive impairment i n elderly spinal surgery patients

目的观察连续监测局部脑氧饱和度(rSO_(2))的目标导向管理对老年脊柱手术患者术后早期神经认知障碍(PND)的影响。方法选取2018年11月至2019年7月山西医科大学第二医院择期行后路腰椎椎体间融合术患者60例,按随机数字表法分为两组,即对照组和干预组各30例。记录麻醉诱导前(T0)、麻醉诱导后10 min(T_(1))、俯卧位后10 min(T_(2))、椎管减压后10 min(T_(3))、椎管减压后30 min(T_(4))和拔管后10 min(T_(5))的rSO_(2);记录术中rSO_(2)基础值、rSO_(2)最小值(rSO_(2)min)、rSO_(2)平均值(rSO_(2)mean)及rSO_(2)较基础值下降的最大百分比(rSO_(2)%max)。当干预组rSO_(2)<55%或rSO_(2)%max>10%,且持续时间>15 s时.则采取调整头部位置,调节血压、增大FiO_(2)及调节呼吸参数增大PgCO_(2)等措施直至rSO_(2)恢复至要求范围;对照组对术中rSO_(2)不予干预。术后7 d采用神经心理学测试评估两组患者的认知功能,术后30 d使用认知功能电话问卷修订版(TICS-m)对患者进行随访,分别记录患者的术后神经认知障碍(PND)发生情况。记录两组患者围术期资料及术后不良反应。结果T_(3)、T_(4)时,干预组rSO2显著高于对照组(P<0.01)。干预组术中rSO_(2) min和rSO_(2)mean高于对照组,rSO_(2)%max低于对照组(P<0.05)。干预组术后7 d PND发生率、气管拔管时间PACU停留时间、住院时间及术后不良反应均低于对照组(P<0.05)。两组患者术后30d PND发生率差异无统计学意义(P>0.05)。结论rSO_(2)的目标导向管理可以降低老年脊柱手术患者术后早期PND发生率,有利于患者术后快速康复。

Objective To observe the effect of goal-oriented management of continuous monitoring of regional cerebral oxygen saturation(rSO_(2))on early postoperative neurocognitive disorders(PND)in elderly spinal surgery patients.Methods FVom November 2018 to July 2019,60 patients undergoing posterior lumbar interbody fusion in the Second Hospital of Shanxi Medical University were selected and randomly divided into control group and intervention group,30 cases in each group.RSO_(2) was recorded before anesthesia induction(T_(0)),10 min after anesthesia induction(T_(1)),10 min after prone position(T_(2)),10 min after spinal decompression(T_(3)),30 min after spinal decompression(T_(4))and 10 min after extubation(T_(5));The basic value of rSO_(2),the minimum value of rSO_(2)(rSO_(2)min),the average value of rSO_(2)(rSO_(2)mean)and the maximum percentage of decrease of rSO_(2)(rSO_(2)%max were recorded.When rSO_(2)<55% or rSO_(2)%max>10%and the duration was longer than 15 s,the intervention group took measures such as adjusting head position,adjusting blood pressure,increasing Fi02 and respiratory parameters,increasing PKTC0_(2) until rSO_(2) returned to the required range;The control group did not interfere with the intraoperative rSO_(2).Neuropsychological tests were used to evaluate the cognitive function of the two groups 7 days after operation.The patients were followed up 30 days after operation with the revised cognitive function telephone questionnaire(TICS-M).The incidence of postoperative neurocognitive impairment(PND)was recorded.The perioperative data and postoperative adverse reactions of the two groups were recorded.Results At T_(3) and T_(4),the rSO_(2) of the intervention group was significantly higher than that of the control group(P<0.01),the intraoperative rSO_(2)min and rSO_(2) mean of the intervention group were higher than the control group,and the rSO_(2)%max was lower than the control group(P<0.05).The incidence of PND 7 days after surgery,extubation time,postanesthesia care unit(PACU)stay time,hospital stay and postoperative adverse reactions in the intervention group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of PND 30 days after operation between the two groups(P>0.05).Conclusions The goal-oriented management of rSO_(2) can reduce the incidence of early postoperative PND in elderly spine surgery patients,which is conducive to the rapid recovery of patients after surgery.