| 摘要: |
| ［摘要］ 目的 探讨心脏手术患者术中脑组织氧饱和度(rScO2)和神经损伤标志物与术后谵妄(POD)的关联性。方法 选择2020年1月至2021年6月于河南省胸科医院行体外循环(CPB)下心脏瓣膜置换手术患者60例，剔除3例，根据患者术后3 d内发生POD情况将其分为POD组（15例）和非POD组（NPOD组，42例）。术中应用近红外光谱仪连续监测患者rScO2和脉搏血氧饱和度(SpO2)，计算动脉-脑组织氧饱和度差（da-rScO2）。分别于麻醉诱导前10 min(T0)、麻醉诱导后10 min(T1)、CPB开始即刻(T2)、CPB结束时(T3)、术毕(T4)、入重症监护室(ICU)时(T5)、术后1 d(T6)、术后2 d(T7)和术后3 d(T8)抽取患者中心静脉血，用ELISA法测定血清中神经损伤标志物S100β蛋白和神经元特性烯醇化酶(NSE)的水平。比较两组以上观测数据并分析其与POD发生的关联性。结果 两组年龄、体重、身高、性别、病因、合并症、吸烟史、饮酒史，以及基础血氧饱和度、rScO2基线值等比较差异无统计学意义（P>0.05）。与NPOD组比较，POD组主动脉阻断时间较长，脑灌注时间、CPB时间较短，但差异均无统计学意义（P>0.05）。POD组术中rScO2降低的幅度>25%持续时间显著长于NPOD组（P<0.05）。在CPB过程中，POD组平均动脉压最小值和rScO2最小值小于NPOD组，而da-rScO2最大值以及da-rScO2>50%持续时间、da-rScO2>40%持续时间、rScO2<50%持续时间、rScO2<40%持续时间均显著大于NPOD组，差异有统计学意义（P<0.05）。在T0～T8时两组血清神经损伤标志物S100β和NSE水平均呈上升趋势，且POD组上升幅度更大。在T2～T8时间点，POD组的血清S100β和NSE水平均高于NPOD组，差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示，在CPB过程中更长的rScO2降低幅度>25%持续时间、rScO2<40%持续时间和da-rScO2>50%持续时间，以及更高水平的血清S100β和NSE是促进POD发生的危险因素（P<0.05）。结论 CPB过程中，更长的rScO2降低幅度>25%持续时间、rScO2<40%持续时间和da-rScO2>50%持续时间是CPB下心脏手术患者发生POD的危险因素，而神经损伤标志物S100β和NSE水平的升高也与POD发生具有关联。 |
| 关键词: 体外循环 术后谵妄 脑组织氧饱和度 心脏手术 神经损伤标志物 |
| DOI：10.3969/j.issn.1674-3806.2022.01.06 |
| 分类号:R 614 |
| 基金项目:河南省重点研发与推广专项（科技攻关）项目（编号：212102310720） |
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| A study on the correlation of intraoperative regional cerebral oxygen saturation and nerve injury markers with postoperative delirium in patients undergoing heart surgery |
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ZHOU Jun-hui, GAO Jie, MENG Xian-hui
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Department of Anesthesiology, Henan Provincial Chest Hospital, Zhengzhou 450008, China
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| Abstract: |
| ［Abstract］ Objective To explore the correlation of intraoperative regional cerebral oxygen saturation(rScO2) and nerve injury markers with postoperative delirium(POD) in patients undergoing heart surgery. Methods Sixty patients undergoing heart valve replacement surgery under cardiopulmonary bypass(CPB) in Henan Provincial Chest Hospital from January 2020 to June 2021 were selected, and 3 of them were excluded. The patients were divided into POD group(15 cases) and non-POD group(NPOD group, 42 cases) according to the occurrence of POD within 3 days after operation. During the operation, a near-infrared spectrometer was used to continuously monitor the patients′ rScO2 and pulse oximetry(SpO2). The difference in artery-rScO2(da-rScO2) was calculated. The patients′ central venous blood was drawn to determine the serum levels of nerve injury marker S100β protein and neuron-specific enolase(NSE) 10 minutes(min) before induction of anesthesia(T0), 10 min after induction of anesthesia(T1), immediately after CPB(T2), at the end of CPB(T3), after operation(T4), when the patients were admitted to the intensive care unit(ICU)(T5), and 1 day(T6), 2 days(T7) and 3 days(T8) after operation, respectively, using enzyme-linked immunosorbent assay(ELISA) method. The above observation data were compared between the two groups, and the correlation between these observation data and the occurrence of POD was analyzed. Results There were no significant differences between the two groups in age, weight, height, gender, etiology, comorbidities, history of smoking, history of drinking, as well as basic blood oxygen saturation and baseline value of rScO2(P>0.05). Compared with the NPOD group, the POD group had longer aortic occlusion time, shorter cerebral perfusion time and CPB time, but the differences were not statistically significant(P>0.05). The duration of intraoperative reduction of rScO2>25% in the POD group was significantly longer than that in the NPOD group(P<0.05). During CPB, the minimum mean arterial pressure and the minimum rScO2 in the POD group were lower than those in the NPOD group, while the maximum da-rScO2 and the duration of da-rScO2>50%, the duration of da-rScO2>40%, the duration of rScO2<50% and the duration of rScO2<40% in the POD group were significantly greater than those in the NPOD group, and the differences were statistically significant(P<0.05). From T0 to T8, the levels of serum nerve injury markers S100β and NSE in the two groups showed an upward trend, and the increase in the POD group was greater. From T2 to T8 time points, the levels of serum S100β and NSE in the POD group were higher than those in the NPOD group, and the differences were statistically significant(P<0.05). The results of multivariate logistic regression analysis showed that the longer duration of rScO2 reduction>25%, the duration of rScO2<40% and the duration of da-rScO2>50% during CPB, and higher levels of serum S100β and NSE were the risk factors promoting the occurrence of POD(P<0.05). Conclusion During CPB, longer duration of rScO2 reduction>25%, duration of rScO2<40%, and duration of da-rScO2>50% are risk factors for promoting the occurrence of POD in patients undergoing heart surgery under CPB, and the elevated levels of nerve injury markers S100β and NSE are also associated with the occurrence of POD. |
| Key words: Cardiopulmonary bypass(CPB) Postoperative delirium(POD) Regional cerebral oxygen saturation(rScO2) Heart surgery Nerve injury markers |
