Prediction of cognitive dysfunction and patients' outcome following valvular heart surgery and the role of cerebral oximetry
Prediction of cognitive dysfunction and patients' outcome following valvular heart surgery and the role of cerebral oximetry
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DOI：
10.1016/j.ejcts.2008.01.012
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发表时间：
2008-04-01
影响因子：
3.4
通讯作者：
Kwak, Young Lan
中科院分区：
文献类型：
--
作者：
Hong, Seong Wook;Shim, Jae Kwang;Kwak, Young Lan
目的：心脏手术后常见的认知功能障碍(POCD)影响患者的预后。脑血氧仪无创性测量局部脑氧饱和度(RSO(2))，据报道，术中脑氧饱和度与POCD以及冠状动脉旁路移植术后患者的预后显著相关。然而，在心脏瓣膜手术(VHS)中证据有限。我们研究了VHS患者术中RSO(2)值与POCD和术后住院时间的关系。方法：100例择期VHS患者入选。分别于术前1天和术后7天采用简易智力状态检查、特质形成测验(A部分)、槽形钉板测验进行神经认知功能评定。术中持续监测RSO(2)，连续5分钟记录RSO(2)值下降的发生率和持续时间：(1)RSO(2)绝对值下降至50%以下，(2)下降40%，(3)较基线值下降20%。结果：23例(23%)患者出现POCD。我们没有观察到POCD患者和非POCD患者在RSO(2)值下降的发生率或持续时间上有任何显著差异。低文化程度和较高的基线温度与POCD显著相关。脑减饱和的患者术后住院时间明显延长。结论：在VHS患者中，脑氧饱和度测定不能预测POCD。然而，术中脑减饱和的患者术后住院时间明显延长，脑氧饱和度监测在监测脑作为全身灌注的指标器官和改善患者预后方面似乎是有前景的。(C)2008年欧洲胸心外科协会。爱思唯尔出版，版权所有。
Objective: Postoperative cognitive dysfunction (POCD) commonly develops after cardiac surgery affecting patients' outcome. Cerebral oximetry noninvasivety measures regional cerebral oxygen saturation (rSO(2)) and significant correlation has been reported between intraoperative cerebral desaturation and POCD, as well as patients' outcome following coronary artery bypass grafting. However, evidence is limited in valvular heart surgery (VHS). We investigated the relationship of intraoperative rSO(2) values with POCD and length of postoperative hospitalization in patients undergoing VHS. Methods: One hundred patients undergoing elective VHS were enrolled. Neurocognitive evaluation was performed with Mini-Mental State Examination, Trait-Making Test (Part A), and Grooved Pegboard Test at 1 day before and 7th day after surgery. During surgery, rSO(2) was continuously monitored and the incidence and duration of decrease in rSO(2) values for five consecutive minutes were recorded as follows; (1) decrease in absolute rSO(2) values to less than 50%, (2) 40%, and (3) a 20% decrease compared to baseline value. Results: Twenty-three patients (23%) demonstrated POCD. We could not observe any significant differences in either the incidence or duration of decrease in rSO(2) values between patients with and without POCD. Low education level and higher baseline temperature had significant correlation with POCD. Patients with cerebral desaturation required significantly longer postoperative hospitalization. Conclusion: In patients undergoing VHS, POCD could not be predicted with cerebral oximetry. However, patients with intraoperative cerebral desaturation required significantly longer postoperative hospitalization and cerebral oximetry appears to be promising in terms of monitoring the brain as the index organ for systemic perfusion and improving patients' outcome. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.