Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia
Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia
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DOI：
10.1213/01.ane.0000166974.96219.cd
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发表时间：
2005-09-01
影响因子：
5.7
通讯作者：
Monaco, F
中科院分区：
文献类型：
--
作者：
Casati, A;Fanelli, G;Monaco, F
老年患者比年轻患者更容易发生脑去饱和，因为随着年龄的增长，生理储备减少。为了评估监测脑氧饱和度（602）是否能最大限度地减少术中脑去饱和，我们前瞻性地监测了122例全身麻醉下接受腹部大手术的老年患者的rSO（2）。患者被随机分配到干预组（监测仪可见，rSO（2）维持在诱导前值的≥ 75%; n = 56）或对照组（监测仪盲法，常规麻醉管理; n = 66）。治疗组11例（20%）和对照组15例（23%）观察到脑饱和度下降（rSO（2）降低<基线的75%）（P = 0.82）。是说平均rSO（2）的（95%置信区间）值，较高（66% [64%-68%]）和低于基线的曲线下面积< 75%（AUCrSO 2（2）<基线的75%）较低（0.4 min% [0.1-0.8 min%]），治疗组患者高于对照组患者（分别为61% [59%-63%]和80 min% [2-144 min%]; P = 0.002和P = 0.017）。当仅考虑术中发生脑饱和度下降的患者时，在对照组中观察到术后第7天的简易精神状态消除（MMSE）评分较低（26 [25-30]）比治疗组（28 [26-30]）（P = 0.02），AUCrSO（2）<基线的75%与术后MMSE评分较术前值下降之间存在显着相关性（r（2）= 0.25，P = 0.01）。对照组患者术中脑氧饱和度下降也经历了较长的时间麻醉后监护室（PACU）出院（47分钟[13-56分钟]）和更长的住院时间（24天[7-53]天）与治疗组患者相比（分别为25分钟[15-35分钟]和10天[7-23天]; P = 0.01和P = 0.007）。使用rSO（2）监测来管理接受腹部大手术的老年患者的麻醉，减少了大脑对缺氧的潜在暴露;这可能与对认知功能的影响减少以及PACU和住院时间缩短有关。
Elderly patients are more prone than younger patients to develop cerebral desaturation because of the reduced physiologic reserve that accompanies aging. To evaluate whether monitoring cerebral oxygen saturation (602) minimizes intraoperative cerebral desaturation, we prospectively monitored rSO(2) in 122 elderly patients undergoing major abdominal surgery with general anesthesia. Patients were randomly allocated to an intervention group (the monitor was visible and rSO(2) was maintained at >= 75% of preinduction values; n = 56) or a control group (the monitor was blinded and anesthesia was managed routinely; n = 66). Cerebral desaturation (rSO(2) reduction < 75% of baseline) was observed in 11 patients of the treatment group (20%) and 15 patients of the control group (23%) (P = 0.82). Mean (95% confidence intervals) values of mean rSO(2), were higher (66% [64%-68%]) and the area under the curve below < 75% of baseline (AUCrSO2(2)< 75% of baseline) was lower (0.4 min% [0.1-0.8 min%]) in patients of the treatment group than in patients of the control group (61% [59%-63%] and 80 min% [2-144 min%],respectively; P = 0.002 and P = 0.017). When considering only patients developing intraoperative cerebral desaturation, a lower Mini Mental State Elimination (MMSE) score was observed at the seventh postoperative day in the control group (26 [25-30]) than in the treatment group (28 [26-30]) (P = 0.02), with a significant correlation between the AUCrSO(2) < 75% of baseline and postoperative decrease in MMSE score from preoperative values (r(2) = 0.25, P = 0.01). Patients of the control group with intraoperative cerebral desaturation also experienced a longer time to postanesthesia care unit (PACU) discharge (47 min [13-56 min]) and longer hospital stay (24 days [7-53] days) compared with patients of the treatment group (25 min [15-35 min] and 10 days [7-23 days], respectively; P = 0.01 and P = 0.007). Using rSO(2) monitoring to manage anesthesia in elderly patients undergoing major abdominal surgery reduces the potential exposure of the brain to hypoxia; this might be associated with decreased effects on cognitive function and shorter PACU and hospital stay.