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Received:May 04, 2022 Published Online:January 20, 2023
Received:May 04, 2022 Published Online:January 20, 2023
中文摘要: 目的探讨术中脑氧饱和度（rSO2）预测老年开胸手术患者术后谵妄（POD）的临床价值。
方法回顾性纳入2018年6月至2021年12月邯郸市中心医院住院治疗的378例开胸手术老年患者，依据术后3d是否发生POD，分为POD组73例（19.31%）、非POD组305例（80.69%）。提取患者临床资料，采用多因素logistic回归分析POD发生的危险因素，采用ROC曲线评定rSO2预测POD的效能。
结果单因素分析显示，POD组年龄＞75岁、糖尿病、机械通气、术后转ICU、睡眠障碍的发生率以及rSO2较基础值降低的最大百分数（rSO2%max）高于非POD组，术中rSO2均值低于非POD组，差异有统计学意义（P＜0.05）。多因素logistic回归分析结果显示，年龄＞75岁（OR=1.255，P=0.013）、术前睡眠障碍（OR=1.500，P=0.027）、rSO2%max＞22.75%（OR=1.833，P=0.005）是老年开胸手术患者发生POD的独立危险因素。ROC曲线表明，rSO2%max预测老年开胸手术患者发生POD的AUC最高（0.892），其次为年龄（0.786），睡眠障碍预测的效能最低（0.731）。
结论术中rSO2降低是老年开胸手术患者发生POD的独立危险因素，监测rSO2变化有助于预测POD发生风险并早期干预。
Abstract:ObjectiveToexploretheclinicalvalueofintraoperativeregionalcerebraloxygensaturation（rSO2）inpredictingpostoperativedelirium（POD）inelderlypatientsundergoingthoracotomy.
MethodsAtotalof378elderlypatientsundergoingthoracotomyinHandanCentralHospitalfromJune2018toDecember2021wereretrospectivelyselectedanddividedintoPODgroup（n=73,19.31%）andnon-PODgroup（n=305,80.69%）accordingtowhetherornotPODoccurred3daysaftersurgery.TheclinicaldatawereextractedandmultivariatelogisticregressionwasusedtoanalyzetheriskfactorsofPOD,andtheefficacyofrSO2inpredictingPODwasevaluatedbydrawingtheROCcurve.
ResultsUnivariateanalysisshowedthattheproportionofpatientsmorethan75yearsold,withdiabetes,mechanicalventilation,ICUadmissionaftersurgeryandsleepdisorders,andthemaximumpercentageofthedecreasedrSO2comparedtobaselinevalues（rSO2%max）inPODgroupweresignificantlyhigherthanthoseinnon-PODgroup,andthemeanintraoperativerSO2wasstatisticallylowerthanthatinnon-PODgroup（P＜0.05）.Multivariatelogisticregressionanalysisshowedthatoldage（morethan75yearsold,OR=1.255,P=0.013）,preoperativesleepdisorder（OR=1.500,P=0.027）andrSO2%max＞22.75%（OR=1.833,P=0.005）weretheindependentriskfactorsforPODinelderlypatientsundergoingthoracotomy.ROCcurveanalysisshowedthatAUCofrSO2%maxinpredictingPODwasthehighest（0.892）,followedbyoldage（0.786）andsleepdisorder（0.731）.
ConclusionIntraoperativerSO2declineisanindependentriskfactorforPODinelderlypatientsundergoingthoracotomy,andmonitoringrSO2ishelpfulforpredictingtheriskofPODandearlyintervention.
文章编号： 中图分类号：R619 文献标志码：B
基金项目:河北省医学科学研究课题计划（20210382）
| Author Name | Affiliation |
| WANGJia-zheng,ZHANGDong-ying,CHENHui-xia,ZHANGLei,LIUPan-pan | Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056001, China |
| Author Name | Affiliation |
| WANGJia-zheng,ZHANGDong-ying,CHENHui-xia,ZHANGLei,LIUPan-pan | Department of Anesthesiology, Handan Central Hospital, Handan, Hebei 056001, China |
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