摘要
目的探讨术中局部脑氧饱和度(regional cerebral oxygen saturation,rSO_(2))监测对行机器人辅助腹腔镜肾盂成形术的婴幼儿发生术后谵妄(postoperative delirium,POD)的预测价值,并建立预测模型。方法择期行机器人辅助腹腔镜肾盂成形术的患儿30例,年龄<4岁,ASA分级Ⅰ、Ⅱ级。监测并记录患儿麻醉诱导前(T_(0))、气管插管后(T_(1))、气腹5 min(T_(2))、气腹0.5 h(T_(3))、气腹1 h(T_(4))、气腹2 h(T_(5))、气腹结束5 min(T_(6))、拔管5 min(T_(7))的心率、MAP、SpO_(2)、rSO_(2)及T_(1)~T_(6)时的PETCO_(2);记录手术时间、麻醉时间、拔管时间及术中芬太尼用量、液体用量、失血量和尿量;记录rSO_(2)基础值、rSO_(2)最低值(rSO_(2)_(min))、rSO_(2)平均值(rSO_(2)_(mean)),计算rSO_(2)较基础值下降的最大百分数(rSO_(2)%_(max))。患儿苏醒拔管后20 min内根据康奈尔儿童谵妄量表(the Cornell Assessment of Pediatric Delirium,CAPD)评估POD的发生情况,根据CAPD评分将其分为谵妄组和非谵妄组。Logistic回归分析发生POD的独立危险因素,受试者工作特征(receiver operating characteristic,ROC)曲线评价rSO_(2)对POD发生的预测价值,并建立列线图模型。结果与非谵妄组比较,谵妄组患儿T_(0)~T_(7)时心率、MAP、SpO_(2)和T_(1)~T_(6)时PETCO_(2)差异均无统计学意义(P>0.05),T_(1)、T_(2)、T_(4)~T_(7)时rSO_(2)降低(P<0.05);与非谵妄组比较,谵妄组患儿rSO_(2)基础值差异无统计学意义(P>0.05),但rSO_(2)_(min)和rSO_(2)_(mean)降低,rSO_(2)%_(max)升高(P<0.05);其他指标两组差异无统计学意义(P>0.05)。二元Logistic回归分析显示:rSO_(2)%_(max)是POD的影响因素(P<0.05)。ROC曲线分析显示:rSO_(2)%_(max)的临界值为3.18%时,约登指数最大,敏感度和特异性分别为77.3%和86.7%,预测POD的曲线下面积(area under curve,AUC)为0.840。列线图模型验证C‑index为0.735,校准预测模型与理想曲线走势基本一致。结论rSO_(2)%_(max)是机器人辅助腹腔�
Objective To explore the value of intraoperative regional cerebral oxygen saturation(rSO_(2))monitoring in predicting postoperative delirium(POD)in infants undergoing robot assisted laparoscopic pyeloplasty,and to establish a prediction model.Methods Thirty pediatric patients,aged<4 years and American Society of Anesthesiologists(ASA)gradeⅠorⅡ,underwent robot assisted laparoscopic pyeloplasty.Monitor and record the heart rate,mean arterial pressure(MAP),pulse oxygen saturation(SpO_(2)),rSO_(2)before anesthesia induction(T_(0)),after intubation(T_(1)),pneumoperitoneum for 5 min(T_(2)),pneumoperitoneum for 0.5 h(T_(3)),pneumoperitoneum for 1 h(T_(4)),pneumoperitoneum for 2 h(T_(5)),pneumoperitoneum for 5 min(T_(6)),extubation for 5 min(T_(7))and end expiratory carbon dioxide partial pressure(PETCO_(2))at T_(1)‒T_(6).The operation time,anesthesia time,extubation time,fentanyl dosage,liquid dosage,blood loss and urine volume during the operation were recorded.The basic value,minimum value(rSO_(2)_(min))and average value(rSO_(2)_(mean))of rSO_(2)were recorded,and the maximum percentage drop of rSO_(2)(rSO_(2)%_(max))were calculated.The occurrence of POD in pediatric patients was evaluated within 20 min after extubation according to the Cornell Assessment of Pediatric Delirium(CAPD)scale,and they were divided into delirium group and non delirium group according to the CAPD score.Logistic regression was used to analyze the independent risk factors of delirium,receiver operating characteristic curve(ROC)was used to evaluate the predictive value of rSO_(2)for POD,and a monogram model was established.Results Compared with non delirium group,heart rate,MAP,SpO_(2)at T_(0)‒T_(7)and PETCO_(2)at T_(1)‒T_(6)in delirium group had no significant difference(P>0.05),while rSO_(2)at T_(1),T_(2)and T_(4)‒T_(7)decreased(P<0.05).Compared with non delirium group,there was no significant difference in the basic value of rSO_(2)in delirium group(P>0.05),but rSO_(2)_(min)and rSO_(2)_(mean)decreased,and rSO_(2)%_(max)increased(P
作者
李海文
郭航
马亚群
Li Haiwen;Guo Hang;Ma Yaqun(College of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Seventh Medical Cen-ter of PLA General Hospital,Beijing 100010,China)
出处
《国际麻醉学与复苏杂志》
CAS
2022年第12期1264-1269,共6页
International Journal of Anesthesiology and Resuscitation
关键词
脑氧饱和度
术后谵妄
婴幼儿
机器人辅助腹腔镜手术
肾盂成形术
Cerebral oxygen saturation
Postoperative delirium
Infant
Robot assisted laparoscopic surgery
Pyeloplasty
