Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery
Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery
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DOI：
10.1016/j.athoracsur.2008.08.070
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发表时间：
2009-01-01
影响因子：
4.6
通讯作者：
Parr, Grant V. S.
中科院分区：
文献类型：
--
作者：
Slater, James P.;Guarino, Theresa;Parr, Grant V. S.
背景先前的研究报告了心脏手术患者术后认知功能下降的发生率为11%至75%。INVOS脑血氧仪（Somanetics Corp，Troy，MI）是美国食品药品监督管理局批准的测量局部脑氧（rSO（2））饱和度的器械。本研究的目的是检测rSO 2降低是否预示着冠状动脉旁路移植术（CABG）后认知功能下降和住院时间延长。在一组初次CABG患者中，术中监测rSO（2）。患者被前瞻性随机分配至设盲对照组或非设盲干预组。在术前、术后和3个月时使用一系列标准化神经认知测试评估认知功能。认知下降定义为至少一项神经认知测量的表现降低一个标准差或更多。rSO（2）去饱和评分通过将rSO（2）低于50%乘以时间（秒）计算。多变量逻辑回归模型用于评估认知功能下降和住院时间。认知能力的变化也采用多元线性回归模型进行评估。rSO（2）去饱和评分大于3，000%-秒的患者术后早期认知功能下降的风险显著较高[p = 0.024]。rSO 2去饱和度评分大于3,000%-秒的患者住院时间延长（> 6天）的风险也增加近3倍[p = 0.007]。术中脑氧饱和度下降与CABG术后认知功能下降和住院时间延长的风险显著相关。
Background. Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSO(2)) saturation. The purpose of this study is to examine whether decreased rSO2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG).Methods. The rSO(2) was monitored intraoperatively in a cohort of primary CABG patients. Patients were prospectively randomized to a blinded control group or an unblinded intervention group. Cognitive function was assessed preoperatively, postoperatively, and at 3 months using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. The rSO(2) desaturation score was calculated by multiplying rSO(2) below 50% by time ( seconds). Multivariate logistic regression models were used to assess cognitive decline and hospital stay. The change in cognitive performance was also assessed using a multivariate linear regression model.Results. Patients with rSO(2) desaturation score greater than 3,000%-second had a significantly higher risk of early postoperative cognitive decline [p = 0.024]. Patients with rSO2 desaturation score greater than 3,000%-second also had a near threefold increased risk of prolonged hospital stay (> 6 days) [p = 0.007].Conclusions. Intraoperative cerebral oxygen desaturation is significantly associated with an increased risk of cognitive decline and prolonged hospital stay after CABG.