摘要
目的探索心血管手术中脑氧饱和度值(rSO_2)的降低与发生术后认知功能障碍(POCD)的相关性,观察术中干预调节rSO_2能否降低POCD的发生率。方法将接受深低温停循环患者31例纳入实验组,并进一步随机分为干预组(n=11,体外循环期间维持rSO_2不低于基础值的20%)和非干预组(n=20,对rSO_2不做任何调节)。同时将体外循环相同时长患者21例纳入对照组。2组患者术中均采用近红外光谱仪持续监测rSO_2。术后1周评价每组患者POCD发生情况。结果实验组患者左脑rSO_2降低基础值20%以下及POCD的发生率明显高于对照组,差异有统计学意义(P<0.05)。术中rSO_2的降低与POCD之间有相关性(P<0.05)。干预组POCD发生率明显低于非干预组,差异有统计学意义(P<0.05)。结论心血管手术中rSO_2降低可能诱发POCD,术中维持rSO_2可减少POCD的发生。
Objective To investigate the correlation of decreasing cerebral regional oxygen saturation（rSO2） with postoperative cognitive dysfunction（POCD） and to assess the value of maintaining rSO2 to assist in management of POCD in cardiac surgery patients. Methods This study enrolled 52 patients scheduled to undergo selective cardiac surgery（including aortic arch replacement,replacement of the ascending aorta,descending aorta stenting,pulmonary embolectomy,and valve replacement surgery）. The trial group（n=31,group T）,underwent deep hypothermic circulatory arrest. Group T was randomized into an intervention group（n=11,group I）,with maintaining rSO2 not less than 20% of baseline value,and a non-intervention group（n=20,group N）,with no treatment for rSO2. The control group（n=21,group C） underwent cardiopulmonary bypass. The rSO2 index was continuously monitored with near-infrared spectroscopy（FORE-SIGHT）. Cognitive status the day before surgery and the status of POCD one week after surgery were evaluated and recorded. Results In group T,the incidence of intraoperative rSO2 values less than 20% of baseline in the left cerebral hemisphere and the POCD were significantly higher than in group C（P〈0.05）. Decreasing intraoperative rSO2 values show a good correlation with the incidence of POCD（P〈0.05）. In group I,the incidence of POCD was significantly lower than in group N（P〈0.05）. Conclusion In cardiac surgery,this study highlighted the associations between decreasing rSO2 and the incidence of POCD. Maintaining rSO2 balance can improve POCD outcomes.
作者
孙聪
皮晓丽
陈莹
刘刚
王俊
SUN Cong1,2,PI Xiaoli2,CHEN Ying1,LIU Gang1,WANG Jun1(1. Department of Anesthesiology, The First Hospital, China Medical University, Shenyang 110001, China; 2. Department of Anesthesiology, Liaoning Province People’s Hospital, Shenyang 110016, Chin)
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2018年第7期631-636,共6页
Journal of China Medical University
关键词
脑氧饱和度
术后认知功能障碍
深低温停循环
体外循环
心血管手术
cerebral regional oxygen saturation
postoperative cognitive dysfunction
deep hypothermia and circulatory arrest
cardiopulmonary circulation
cardiac surgery
