局部脑组织的氧饱和度对体外循环心脏手术患者术后谵妄的影响

余慧佳 王瑞英 朱迪 葛杨玲 张胜

[摘要] 目的 探讨局部脑组织的氧饱和度对体外循环心脏手术患者术后谵妄的影响。 方法 选择2018年1月至2020年10月在我院行体外循环心脏手术患者60例的临床资料进行回顾性分析，其中30例未发生术后谵妄为对照组，30例发生术后谵妄为观察组。比较两组术中不同时间点rSO2水平及术前术后MMSE评分。选择患者术中rSO2水平最低值与MMSE评分进行相关性分析。 结果 （1）两组在体外循环复温时rSO2水平最低，随后逐渐回升，组内不同时间点比较，差异有统计学意义（P<0.05）;觀察组体外循环开始时、体外循环降温时、体外循环复温时、体外循环停机时、体外循环停机后30 min rSO2水平均显著高于对照组，差异有统计学意义（P<0.05）。（2）术后两组MMSE评分低于术前，差异有统计学意义（P<0.05）;术后观察组MMSE评分显著高于对照组，差异有统计学意义（P<0.05）。（3）患者术中rSO2水平与术后MMSE评分呈显著正相关（r=0.921，P=0.000）。 结论 体外循环心脏手术后发生谵妄的患者术中rSO2有一个显著的下降过程，且患者术中rSO2最低值与MMSE评分有显著的相关性。

[关键词] 局部脑组织氧饱和度;体外循环;心脏手术;谵妄

[中图分类号] R654.2          [文献标识码] A          [文章编号] 1673-9701（2021）30-0022-04

[Abstract] Objective To investigate the effect of local brain tissue oxygen saturation on postoperative delirium in patients undergoing cardiopulmonary bypass surgery. Methods The clinical data of 60 patients who underwent cardiopulmonary bypass cardiac surgery in our hospital from January 2018 to October 2020 were selected for retrospective analysis. Among them，30 cases without postoperative delirium were selected as the control group，and 30 cases with postoperative delirium were selected as the observation group. The levels of rSO2 at different time points and MMSE scores before and after the operation were compared between the two groups. The lowest value of intraoperative rSO2 level and MMSE score were selected for correlation analysis. Results （1）The rSO2 level of the two groups was the lowest during cardiopulmonary bypass rewarming，and then gradually recovered. There was a statistically significant difference at different time points within the group （P<0.05）. The rSO2 levels of the observation group during CPB cooling，CPB rewarming，CPB shutdown，and 30 min after CPB shutdown were significantly higher than those in the control group， and the difference was statistically significant （P<0.05）. （2）The MMSE score of the two groups after the operation was lower than that before the operation， and the difference was statistically significant （P<0.05）. The MMSE score of the postoperative observation group was significantly higher than that of the control group， and the difference was statistically significant （P<0.05）. （3）There was a significant positive correlation between the intraoperative rSO2 level and the postoperative MMSE score （r=0.921， P=0.000）. Conclusion In patients with delirium after cardiopulmonary bypass surgery，there is a significant decrease in rSO2 during the operation，and the lowest value of rSO2 during the operation is significantly correlated with the MMSE score of the patient.

[Key words] Local brain tissue oxygen saturation; Cardiopulmonary bypass; Cardiac surgery; Delirium

体外循环是将人体的静脉血经导管引出或抽吸至体外，经过氧合后使静脉血转变为动脉血，然后再经导管将其输入到人的动脉系统内，完成血液循环。这种人的血液不经过心和肺而在体外进行气体交换和循环的方法，是心脏手术重要的辅助技术，为心脏手术的顺利进行提供保障。……