老年腹腔镜胃肠手术患者脑氧代谢与术后谵妄的关系

摘要 目的　探讨老年腹腔镜胃肠手术患者脑氧代谢与术后谵妄（POD）的关系。 方法　选择择期行腹腔镜胃肠手术患者155例，自入手术室开始持续监测脑血氧饱和度（rScO2）并计算rScO2曲线下面积（AUC-rScO2)，病人进行血气分析，并计算脑摄氧率（CMRO2）。术后3 d内每日以ICU精神错乱评估量表（CAM-ICU）判断患者是否发生谵妄。 结果　155患者中有16例患者发生过谵妄，谵妄发生率为10.32%。谵妄组患者术中rScO2基础值、rScO2最高值、rScO2最低值及AUC-rScO2均有低于非谵妄组患者的趋势，但差异并无统计学意义（P>0.05）。谵妄组患者气腹前、气腹结束即刻动脉CO2分压、葡萄糖浓度、血红蛋白水平、血细胞比容、乳酸水平与非谵妄组患者比较差异无统计学意义（P＞0.05），但谵妄组各指标的变化幅度明显高于非谵妄组（t=2.016～5.833,P＜0.05）。谵妄组患者气腹前、气腹结束即刻CMRO2与非谵妄组患者比较差异无统计学意义（P＞0.05），但谵妄组患者在气腹后的CMRO2的下降幅度明显高于非谵妄组（t=1.985,P＜0.05）。 结论　老年腹腔镜胃肠手术患者谵妄的发生与术中rScO2下降幅度和持续时间无关,与术中CMRO2下降有关。
Abstract：Objective　To investigate the relationship between cerebral oxygen metabolism and postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery. Methods　A total of 155 patients undergoing elective laparoscopic gastrointestinal surgery were enrolled. The regional cerebral oxygen saturation was continuously monitored from the time the patient entering the operating room, and the area under rScO2 curve (AUC-rScO2) was calculated. Blood gas analysis was performed, and cerebral metabolic rate of oxygen (CMRO2) was calculated. The Confusion Assessment Method for the ICU (CAM-ICU) was used daily to determine whether the patient developed delirium within 3 days after the surgery. Results　Of the 155 patients,16 developed delirium, resulting an incidence of 10.32 %. During the surgery, the baseline rScO2, highest rScO2, lowest rScO2, and AUC-rScO2 were lower in the delirium group than in the non-delirium group, but the differences were not statistically significant (P>0.05). There were no significant differences in arterial CO2 partial pressure, glucose concentration, hemoglobin level, hematocrit, and lactate level before and immediately after pneumoperitoneum in the delirium group and the non-delirium group (P>0.05), but the delirium group had significantly greater changes in these parameters than the non-delirium group (t=2.016-5.833,P<0.05). There was no significant difference in CMRO2 before and immediately after pneumoperitoneum between the delirium group and the non-delirium group (P>0.05), but the decrease in CMRO2 after pneumoperitoneum in delirium group was significantly higher than that in the non-delirium group (t=1.985,P<0.05). Conclusion　The development of postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery is not associated with the degree and duration of intraoperative rScO2 decline, but is associated with the decrease in CMRO2 during operation