CPB期间COx目标导向血压管理预防急性A型主动脉夹层手术患者术后谵妄的价值

Value of target blood pressure management based on cerebral oximetry index during CPB in preventing postoperative delirium in patients with acute type A aortic dissection

目的评价体外循环(CPB)期间脑血氧指数(COx)目标导向血压管理预防急性A型主动脉夹层手术患者术后谵妄(POD)的价值。方法选择行急性A型主动脉夹层手术患者157例,年龄18~64岁,性别不限,采用随机数字表法分为2组:传统经验组(C组,n=81)和COx管理组(M组,n=76)。CPB期间,C组维持MAP 60~80 mmHg;M组基于COx获得MAP范围,并将MAP维持在该范围内。观察术后7 d内谵妄发生情况;记录术后7 d内其他相关并发症发生情况、气管拔管时间和心脏外科ICU驻留时间。结果与C组比较,M组POD发生率和严重程度评分降低,持续时间缩短,气管拔管时间和心脏外科ICU驻留时间缩短,术后脑梗死和急性肾损伤发生率降低(P<0.05)。结论CPB期间COx目标导向血压管理有助于减少急性A型主动脉夹层手术患者POD的发生,改善预后。

Objective To evaluate the value of target blood pressure management based on cerebral oximetry index(COx)during cardiopulmonary bypass(CPB)in preventing postoperative delirium(POD)in patients with acute type A aortic dissection(ATAAD).Methods One hundred and fifty-seven patients with ATAAD,aged 18-64 yr,regardless of gender,were divided into 2 groups by a random number table method:traditional experience group(group C,n=81)and COx management group(group M,n=76).The mean arterial pressure in group C was maintained in the traditional range of 60-80 mmHg during CPB.In group M,the mean arterial pressure range was obtained based on the COx and maintained within this range during CPB.The primary outcome assessed was the development of delirium within 7 days after surgery.Secondary outcomes included other postoperative complications,tracheal extubation time,and duration of cardiac intensive care unit stay.Results Compared with group C,the incidence and severity scores of POD were significantly decreased,the duration of POD was shortened,the duration of POD was shortened,the extubation time and duration of cardiac intensive care unit stay were shortened,and the incidence of postoperative cerebral infarction and acute kidney injury was decreased in group M(P<0.05).Conclusions Target blood pressure management based on COx during CPB is helpful in reducing the occurrence of POD and improving the prognosis of patients undergoing surgery for ATAAD.