心脏手术后脑血管自身调节功能及其与谵妄的关系：前瞻性观察性研究
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A prospective, observational study of cerebrovascular autoregulation and its association with delirium following cardiac surgery
背景与目的
本项前瞻性观察性队列研究旨在评估术后脑血管自身调节功能受损与心脏手术后谵妄发生之间的关系。前期研究表明，体外循环期间术中脑血管自身调节功能受损与谵妄有关。然而，脑血管自身调节功能的术后改变及其与谵妄的关系尚无研究报道。
方 法
本研究收集了108名没有基本认知功能障碍或失语症的择期行心脏手术的成年患者。采用近红外光谱法测定脑组织氧饱和度与平均动脉压的 Pearson 相关关系，评价脑血管自身调节功能，得出组织血氧指数。 术后当天和术后第1天监测脑血管自身调节功能至少90min。入住重症监护病房期间，使用混淆评估法对谵妄进行评估。
结 果
108例患者中的有24例发生谵妄。术后当天谵妄患者组织血氧指数平均值(SD)高于非谵妄患者（0.270 [0.199] vs.0.180[0.142], p = 0.044）,但术后第1天无明显差异（0.130 [0.160] vs. 0.150 [0.130], p = 0.543）。所有患者术后第1天组织血氧指数均较术后当天有所改善。逻辑回归分析证明术后当天组织血氧指数与谵妄独立相关（OR 1.05 [95%CI 1.01-1.10]，p = 0.043）。
结 论
总之，我们发现近红外光谱测量的脑血管自身调节功能受损与术后早期谵妄之间存在关联。
原始文献摘要
Chan B, Aneman A. A prospective, observational study of cerebrovascular autoregulation and its association with delirium following cardiac surgery.[J]. Anaesthesia 2019 Jan;74(1). DOI：10.1111/anae.14457
This aim of this prospective observational cohort study was to evaluate any association between postoperatively impaired cerebrovascular autoregulation and the onset of delirium following cardiac surgery. Previous studies have shown that impaired intra-operative cerebrovascular autoregulation during cardiopulmonary bypass is associated with delirium. However, postoperative changes in cerebrovascular autoregulation and its association with delirium have not been investigated. One-hundred and eight consecutive adult cardiac surgical patients without baseline cognitive dysfunction or aphasia were included in the study. Cerebrovascular autoregulation was assessed by the Pearson correlation between near-infrared spectroscopy-derived cerebral tissue oxygen saturation and mean arterial pressure to derive the tissue oximetry index. Cerebrovascular autoregulation was monitored for a minimum of 90 min on postoperative day 0 and postoperative day 1. Delirium was assessed throughout intensive care unit admission using the confusion assessment method for the intensive care unit. We observed delirium in 24 of the 108 patients studied. The mean (SD) tissue oximetry index was higher in delirious patients on postoperative day 0 compared with non-delirious patients; 0.270 (0.199) vs. 0.180 (0.142), p = 0.044, but not on postoperative day 1; 0.130 (0.160) vs. 0.150 (0.130), p = 0.543. All patients showed improvement in tissue oximetry index on postoperative day 1 compared with postoperative day 0. Logistic regression analysis demonstrated tissue oximetry index on postoperative day 0 to be independently associated with delirium; odds ratio 1.05 (95%CI 1.01–1.10), p = 0.043. In conclusion, we found an association between impaired cerebrovascular autoregulation, measured by near-infrared spectroscopy, and delirium in the early postoperative period.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙