老年开胸手术患者术中脑氧饱和度与术后谵妄的相关性

Correlation between intraoperative regional cerebral oxygen saturation and postoperative delirium in elderly patients undergoing thoracotomy

目的探讨术中脑氧饱和度(rSO_(2))预测老年开胸手术患者术后谵妄(POD)的临床价值。方法回顾性纳入2018年6月至2021年12月邯郸市中心医院住院治疗的378例开胸手术老年患者,依据术后3 d是否发生POD,分为POD组73例(19.31%)、非POD组305例(80.69%)。提取患者临床资料,采用多因素logistic回归分析POD发生的危险因素,采用ROC曲线评定rSO_(2)预测POD的效能。结果单因素分析显示,POD组年龄>75岁、糖尿病、机械通气、术后转ICU、睡眠障碍的发生率以及rSO_(2)较基础值降低的最大百分数(rSO_(2)%max)高于非POD组,术中rSO_(2)均值低于非POD组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄>75岁(OR=1.255,P=0.013)、术前睡眠障碍(OR=1.500,P=0.027)、rSO_(2)%max>22.75%(OR=1.833,P=0.005)是老年开胸手术患者发生POD的独立危险因素。ROC曲线表明,rSO_(2)%max预测老年开胸手术患者发生POD的AUC最高(0.892),其次为年龄(0.786),睡眠障碍预测的效能最低(0.731)。结论术中rSO_(2)降低是老年开胸手术患者发生POD的独立危险因素,监测rSO_(2)变化有助于预测POD发生风险并早期干预。

Objective To explore the clinical value of intraoperative regional cerebral oxygen saturation(rSO_(2))in predicting postoperative delirium(POD)in elderly patients undergoing thoracotomy.Methods A total of 378 elderly patients undergoing thoracotomy in Handan Central Hospital from June 2018 to December 2021 were retrospectively selected and divided into POD group(n=73,19.31%)and non-POD group(n=305,80.69%)according to whether or not POD occurred 3 days after surgery.The clinical data were extracted and multivariate logistic regression was used to analyze the risk factors of POD,and the efficacy of rSO_(2) in predicting POD was evaluated by drawing the ROC curve.Results Univariate analysis showed that the proportion of patients more than 75 years old,with diabetes,mechanical ventilation,ICU admission after surgery and sleep disorders,and the maximum percentage of the decreased rSO_(2) compared to baseline values(rSO_(2)%max)in POD group were significantly higher than those in non-POD group,and the mean intraoperative rSO_(2) was statistically lower than that in non-POD group(P<0.05).Multivariate logistic regression analysis showed that old age(more than 75 years old,OR=1.255,P=0.013),preoperative sleep disorder(OR=1.500,P=0.027)and rSO_(2)%max>22.75%(OR=1.833,P=0.005)were the independent risk factors for POD in elderly patients undergoing thoracotomy.ROC curve analysis showed that AUC of rSO_(2)%max in predicting POD was the highest(0.892),followed by old age(0.786)and sleep disorder(0.731).Conclusion Intraoperative rSO_(2) decline is an independent risk factor for POD in elderly patients undergoing thoracotomy,and monitoring rSO_(2) is helpful for predicting the risk of POD and early intervention.