脑氧饱和度监测目标导向技术在老年患者围术期脑保护中的作用

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摘要目的观察脑氧饱和度（rSO2）监测目标导向技术在老年患者围术期脑保护中的作用。方法选取2019年3月—2020年4月于中国人民解放军联勤保障部队第九〇〇医院拟行择期非心脏手术的老年患者60例纳入研究，采用随机数字表法分为rSO2监测组（S组）和常规组（N组），每组30例。S组rSO2下降＞13%时，通过提升血压、增加吸入氧浓度、调整血红蛋白水平等方法及时干预，尽量维持rSO2于基线范围。N组仅行脑部氧饱和度监测，不作临床干预。比较两组术中rSO2下降幅度和持续时间、术后神经系统并发症的发生率和血清皮质醇及S-100β的变化情况。结果 N组术中轻度、中度脑缺氧发生率高于S组；rSO2下降＞13%的曲线下面积明显大于S组（P ＜ 0.05）。两组苏醒延迟发生率比较，差异无统计学意义（P ＞ 0.05），N组术后谵妄发生率明显高于S组（P ＜ 0.05）。两组术后蒙特利尔认知评估量表（MoCA）评分均低于术前，N组术后MoCA评分明显低于S组（P ＜ 0.05）。两组术后血清皮质醇和S-100β含量均高于术前（P ＜ 0.05）。两组术后血清皮质醇含量比较，差异无统计学意义（P ＞ 0.05），N组血清S-100β含量高于S组（P ＜ 0.05）。结论采用rSO2监测目标导向技术有效避免了患者长时间的脑缺氧暴露，进而预防术后神经系统并发症的发生，具有脑保护作用。

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	苏秀珠张燕王丽萍

关键词 ：脑氧饱和度, 老年, 脑保护, 谵妄, 认知功能

Abstract：Objection To observe the effect of cerebral oxygen saturation (rSO2) monitoring goal-oriented technique on perioperative cerebral protection in elderly patients. Methods A total of 60 elderly patients who were scheduled to undergo elective non-cardiac surgery in the 900th Hospital of the Joint Logistics Support Force of the People’s Liberation Army from March 2019 to April 2020 were included in this study. They were devided into rSO2 monitoring group (group S) and routine group (group N) by random number table method, with 30 cases in each group. When rSO2 in group S decreased more than 13%, timely intervention was performed by raising blood pressure, increasing inhaled oxygen concentration, adjusting hemoglobin level and other methods to maintain rSO2 in the baseline range as far as possible. In group N, only cerebral oxygen saturation was monitored without clinical intervention. The decrease amplitude and duration of rSO2 during operation, the incidence of postoperative nervous system complications, and the changes of serum cortisol and S-100β were compared between the two groups. Results The incidence of mild and moderate cerebral hypoxia in group N was higher than that in group S; the area under curve of rSO2 decreased more than 13% in was significantly greater than that in group S (P ＜ 0.05), there was no significant difference in the incidence of delayed awakening between the two groups (P ＞ 0.05). The incidence of postoperative delirium in group N was significantly higher than that in group S (P ＜ 0.05). Postoperative montreal cognitive assessment scale (MoCA) scores in both groups were lower than those before surgery, and MoCA scores in group N were significantly lower than those in group S (P ＜ 0.05). The levels of serum cortisol and S-100β after operation were higher than those before operation (P ＜ 0.05). There was no significant difference in serum cortisol content between the two groups after operation (P ＞ 0.05). Serum S-100β content in group N was higher than that in group S (P ＜ 0.05). Conclusion The use of rSO2 monitoring goal-oriented technique can effectively avoid long-term cerebral hypoxia exposure of patients, thus preventing the occurrence of postoperative nervous system complications, and has a brain protection effect.

Key words： Cerebral oxygen saturation Elderly Neuroprotection Delirium Cognitive function

基金资助:福建省科技创新联合资金项目（2017Y9126）。

通讯作者: 王丽萍（1979.7-），女，博士；研究方向：麻醉学药理与器官保护。

引用本文:

苏秀珠张燕王丽萍. 脑氧饱和度监测目标导向技术在老年患者围术期脑保护中的作用[J]. 中国医药导报, 2021, 18(7): 95-98,112.
SU Xiuzhu ZHANG Yan WANG Liping. Effect of goal-oriented technique of cerebral oxygen saturation monitoring on perioperative cerebral protection in elderly patients. 中国医药导报, 2021, 18(7): 95-98,112.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2021/V18/I7/95

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