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发布时间:2022-04-08 12:11:45

心脏手术患者术中脑组织氧饱和度和神经损伤 标志物与术后谵妄的关联性研究 

周俊辉高 洁孟宪慧 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) 作者单位: 450008 郑州河南省胸科医院麻醉科( 周俊辉孟宪慧) ; 100037 北京中国医学科学院阜外医院麻醉科( 高 洁) 作者简介: 周俊辉医学硕士主治医师研究方向: 心胸外科手术麻醉与脏器保护E-mail: zhicungaoyuan1985@ 163. com 通信作者: 孟宪慧大学本科医学学士主任医师研究方向: 心胸外科手术麻醉与脏器保护E-mail: 13939029331@ 163. com 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 1 月至 2021 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 剔除 3 根据患者术后 3 d 内发生 POD 情况将其分为 POD ( 15 ) 和非 POD ( NPOD 42 ) 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) ( 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) 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 ( P < 0. 05) CPB 过程中POD 组平均动脉压最小值和 rScO2 最小值小于 NPOD 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 差异有统计学意义( P < 0. 05) T0 ~ T8 时两组血清神经损伤 标志物 S100β NSE 水平均呈上升趋势POD 组上升幅度更大T2 ~ T8 时间点POD 组的血清 S100β NSE 水平均高于 NPOD 差异有统计学意义( P < 0. 05) 多因素 logistic 回归分析结果显示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 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 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 中图分类号R 614 文献标识码A 文章编号1674 - 3806( 2022) 01 - 0029 - 06 doi: 10. 3969 /j. issn. 1674 - 3806. 2022. 01. 06

study on the correlation of intraoperative regional cerebral oxygen saturation and nerve injury markers with postoperative delirium in patients undergoing heart surgery ZHOU Jun-huiGAO JieMENG Xian-hui. Department of AnesthesiologyHenan Provincial Chest HospitalZhengzhou 450008China AbstractObjective 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 selectedand 3 of them were excluded. The patients were divided into POD group( 15 cases) and non-POD group( NPOD group42 cases) according to the occurrence of POD within 3 days after operation. During the operationa near-infrared spectrometer was used to continuously monitor the patients' rScO2 and pulse · 92 · 中国临床新医学 2022 1 月 第 15 卷 第 1 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 operationrespectivelyusing enzyme-linked immunosorbent assay( ELISA) method. The above observation data were compared between the two groupsand the correlation between these observation data and the occurrence of POD was analyzed. Results There were no significant differences between the two groups in ageweightheightgenderetiologycomorbiditieshistory of smokinghistory of drinkingas well as basic blood oxygen saturation and baseline value of rScO2 ( P > 0. 05) . Compared with the NPOD groupthe POD group had longer aortic occlusion timeshorter cerebral perfusion time and CPB timebut 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 CPBthe minimum mean arterial pressure and the minimum rScO2 in the POD group were lower than those in the NPOD groupwhile 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 groupand the differences were statistically significant( P < 0. 05) . From T0 to T8the levels of serum nerve injury markers S100β and NSE in the two groups showed an upward trendand the increase in the POD group was greater. From T2 to T8 time pointsthe levels of serum S100β and NSE in the POD group were higher than those in the NPOD groupand 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 CPBand higher levels of serum S100β and NSE were the risk factors promoting the occurrence of POD( P < 0. 05) Conclusion During CPBlonger 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 CPBand the elevated levels of nerve injury markers S100β and NSE are also associated with the occurrence of POD. Key wordsCardiopulmonary bypass( CPB) ; Postoperative delirium( POD) ; Regional cerebral oxygen saturation( rScO2 ) ; Heart surgery; Nerve injury markers


心脏手术患者术中脑组织氧饱...志物与术后谵妄的关联性研究_周俊辉.pdf


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