中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (7): 631-636.doi: 10.12007/j.issn.0258-4646.2018.07.014

• 论著 • 上一篇    下一篇

术中脑氧饱和度监测对心血管手术患者术后认知功能障碍发生率的影响

孙聪1,2, 皮晓丽2, 陈莹1, 刘刚1, 王俊1   

  1. 1. 中国医科大学附属第一医院麻醉科, 沈阳 110001;
    2. 辽宁省人民医院麻醉科, 沈阳 110016
  • 收稿日期:2017-05-24 出版日期:2018-07-30 发布日期:2018-07-03
  • 通讯作者: 王俊 E-mail:wjun2000@hotmail.com
  • 作者简介:孙聪(1987-),女,医师,硕士.

Intraoperative Regional Cerebral Saturation Monitoring May Reduce the Development of Postoperative Cognitive Dysfunction

SUN Cong1,2, PI Xiaoli2, CHEN Ying1, LIU Gang1, WANG Jun1   

  1. 1. Department of Anesthesiology, The First Hospital, China Medical University, Shenyang 110001, China;
    2. Department of Anesthesiology, Liaoning Province People's Hospital, Shenyang 110016, China
  • Received:2017-05-24 Online:2018-07-30 Published:2018-07-03

摘要: 目的 探索心血管手术中脑氧饱和度值(rSO2)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rSO2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rSO2不低于基础值的20%)和非干预组(n=20,对rSO2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rSO2。术后1周评价每组患者POCD发生情况。结果 实验组患者左脑rSO2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rSO2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rSO2降低可能诱发POCD,术中维持rSO2可减少POCD的发生。

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

Abstract: 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.

Key words: cerebral regional oxygen saturation, postoperative cognitive dysfunction, deep hypothermia and circulatory arrest, cardiopulmonary circulation, cardiac surgery

中图分类号: 

  • R614.2
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