局部脑氧饱和度与麻醉深度监测预测非大血管手术患者术后认知功能障碍的价值

Value of regional cerebral oxygen saturation and anesthesia depth in predicting postoperative cognitive dysfunction in patients with non-macrovascular surgery

目的探究局部脑氧饱和度(rScO_(2))与麻醉深度监测预测非大血管手术患者术后认知功能障碍(POCD)的价值。方法回顾性分析2017年8月至2019年6月西安交通大学第一附属医院收治的147例非大血管手术全麻患者,按照术后是否发生POCD分为POCD组(n=37)和无POCD组(n=110),记录麻醉诱导前(T_(0))、气管插管时(T_(1))、手术进行2 h时(T_(2))、术毕(T_(3))、拔管时(T_(4))患者脑电双频指数(BIS)和rScO_(2)变化,并采用受试者工作特征曲线(ROC)分析其对发生POCD的预测价值。结果两组麻醉时间、手术时间、手术类型比较,差异无统计学意义(P>0.05);在T_(0)、T_(1)、T_(4)时两组BIS和rScO_(2)水平差异无统计学意义(P>0.05),T_(2)、T_(3)时POCD组BIS和rScO_(2)水平低于无POCD组,两组BIS、rScO_(2)均在T_(2)时达最低值,此时POCD组rScO_(2)较基础值下降率高于无POCD组[(31.84±3.27)%vs(14.81±2.52)%,P<0.05];绘制BIS-T_(2)、rScO_(2)-T_(2)、BIS-T_(3)、rScO_(2)-T_(3)、rScO_(2)较基础值下降率预测非大血管手术患者发生POCD的ROC曲线,其AUC分别为0.514、0.617、0.505、0.633、0.724,T_(2)时rScO_(2)、BIS联合检测的AUC值最高,为0.808。结论术中局部脑氧饱和度检测联合麻醉深度监测对预测非大血管手术患者发生术后认知功能障碍具有较好的临床应用价值。

Objective To explore the value of regional cerebral oxygen saturation(rScO_(2))and anesthesia depth monitoring in predicting postoperative cognitive dysfunction(POCD)in patients with non-macrovascular surgery.Methods A retrospective analysis of 147 patients with non-macrovascular surgery under general anesthesia admitted to the First Affiliated Hospital of Xi'an Jiaotong University from August 2017 to June 2019 was performed and divided into the POCD group(n=37)and the non-POCD group(n=110)according to the presence/absence of postoperative POCD.The changes of bispectral index(BIS)and rScO_(2) in patients before anesthesia induction(T_(0)),endotracheal intubation(T_(1)),2 hours after operation(T_(2)),after operation(T_(3)),and at extubation(T_(4))were recorded,and the predictive value for the occurrence of POCD was analyzed by receiver operating characteristic(ROC)curve.Results There was no statistically significant difference in anesthesia time,operation time and operation type between the two groups(P>0.05).There was no significant difference in BIS and rScO_(2) levels between the two groups at T_(0),T_(1) and T_(4)(P>0.05).BIS and rScO_(2) levels in the POCD group at T_(2) and T_(3) were lower than those in the non-POCD(P<0.05).Both BIS and rScO_(2) of the two groups reached the lowest value at T_(2),and the reduction rate of rScO_(2) in the POCD group was higher than that in the non-POCD group[(31.84±3.27)%vs(14.81±2.52)%,P<0.05].The ROC curve of BIS-T_(2),rScO_(2)-T_(2),BIS-T_(3),rScO_(2)-T_(3),rScO_(2) reduction from the baseline value to predict POCD in patients with non-macrovascular surgery was plotted,and the AUCs were 0.514,0.617,0.505,0.633,0.724,respectively.The highest AUC value of 0.808 was found for combined detection at T_(2)(rScO_(2) and BIS).Conclusions The combined detection of intraoperative regional cerebral oxygen saturation and anesthesia depth monitoring is of good clinical application value in predicting postoperative cognitive dysfunction in patients with non-macrovascular surgery.