脑氧饱和度在指导糖尿病患者腹部手术术后谵妄的应用情况

王永 成1, 李秀 华2, 高 璐1, 苗 苗1
1.华北理工大学 河北唐山 064300；2.唐山市工人医院 河北唐山 064300

摘要

目的：术后谵妄是指发生在术后7天内或者出院前的认知能力下降。糖尿病患者的微血管变化和认知能力下降之间的关系已经得到证实，在许多研究中，糖尿病患者更容易受到术后谵妄的影响，严重程度受发病年龄和糖尿病持续时间、糖化血红蛋白浓度、大血管和微血管病变、自主神经病变和抑郁症等多种因素的影响。术中应用脑氧饱和度监测 rScO2，可以随时、连惯监测患者的脑氧情况，根据不同患者的不同情况，术中及时调整，减少术后谵妄的发生率，本文拟了解目前临床中脑氧饱和度监测在糖尿病患者行腹部手术的应用情况。

参考

[1]McDaniel M，Brudney C. Postoperative delirium：etiology and management. Curr Opin Crit Care. 2012 Aug；18（4）：372-6. doi：10.1097/MCC.0b013e3283557211. PMID：22732435. [2]Robinson TN，Raeburn CD，Tran ZV，Brenner LA，Moss M. Motor subtypes of postoperative delirium in older adults. Arch Surg. 2011 Mar；146（3）：295-300. doi：10.1001/archsurg.2011.14. PMID：21422360；PMCID：PMC3346288. [3]Leslie DL，Marcantonio ER，Zhang Y，Leo-Summers L，Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008 Jan 14；168（1）：27-32. doi：10.1001/archinternmed.2007.4. PMID：18195192；PMCID：PMC4559525. [4]Dorland H F，Abma F I，Roelen C A M，et al. The cognitive symptom checklist-work in cancer patients is related with work functioning，fatigue and depressive symptoms：a validation study[J]. Journal of Cancer Survivorship，2016，10（3）：545-552. [5]Martins S，Lourenço C，Pinto-de-Sousa J，et al. Validation study of the European Portuguese version of the Confusion Assessment Method（CAM）[J]. International Psychogeriatrics，2015，27（5）：777. [6]Marcantonio ER，Ngo LH，O'Connor M，Jones RN，Crane PK，Metzger ED，Inouye SK. 3D-CAM：derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium ： a cross-sectional diagnostic test study. Ann Intern Med. 2014 Oct 21；161（8）：554-61. doi：10.7326/M14-0865. Erratum in：Ann Intern Med. 2014 Nov 18；161（10）：764. PMID：25329203；PMCID：PMC4319978. [7]Inouye SK，Kosar CM，Tommet D，Schmitt EM，Puelle MR，Saczynski JS，Marcantonio ER，Jones RN. The CAM-S：development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014 Apr 15；160（8）：526-533. doi：10.7326/M13-1927. PMID：24733193；PMCID：PMC4038434. [8]Dotson B. Comparing Dexmedetomidine With Haloperidol for the Treatment of Hyperactive Delirium in Nonintubated ICU Patients. Crit Care Med. 2016 Dec；44（12）：e1259-e1260. doi：10.1097/CCM.0000000000002049. PMID：27858832. [9]Zhang X，Dong H，Li N，et al. Activated brain mast cells contribute to postoperative cognitive dysfunction by evoking microglia activation and neuronal apoptosis[J]. Journal of neuroinflammation，2016，13（1）：1-15. [10]Zhang X，Jiang X，Huang L，et al. Central cholinergic system mediates working memory deficit induced by anesthesia/surgery in adult mice[J]. Brain and Behavior，2018，8（5）：e00957. [11]Kalb A，von Haefen C，Sifringer M，et al. Acetylcholinesteraseinhibitors reduce neuroinflammation and-degeneration in the cortex and hippocampus of a surgery stress rat model[J]. PLoS One，2013，8（5）：e62679. [12]Maldonado J R. Pathoetiological model of delirium ： a comprehensive understanding of the neurobiology of delirium and an evidence-based approach to prevention and treatment[J]. Critical care clinics，2008，24（4）：789-856. [13]Nguyen D N，Huyghens L，Zhang H，et al. Cortisol is an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock[J]. BioMed Research International，2014，2014. [14]Munhoz C D，Sorrells S F，Caso J R，et al. Glucocorticoids exacerbate lipopolysaccharide-induced signaling in the frontal cortex and hippocampus in a dose-dependent manner[J]. Journal of Neuroscience，2010，30（41）：13690-13698. [15]Nguyen D N，Huyghens L，Zhang H，et al. Cortisol is an associated-risk factor of brain dysfunction in patients with severe sepsis and septic shock[J]. BioMed Research International，2014，2014. [16]Aldecoa，César，Bettelli G，Bilotta F，et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium[J]. European Journal of Anaesthesiology，2017，34（4）：192-214. [17]Shaw JE，Sicree RA，Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010 Jan；87（1）：4-14. doi：10.1016/j.diabres.2009.10.007. Epub 2009 Nov 6. PMID：19896746. [18]van Bussel FCG，Backes WH，Hofman PAM，van Oostenbrugge RJ，van Boxtel MPJ，Verhey FRJ，Steinbusch HWM，Schram MT，Stehouwer CDA，Wildberger JE，Jansen JFA. Cerebral Pathology and Cognition in Diabetes：The Merits of Multiparametric Neuroimaging. Front Neurosci. 2017 Apr 5；11：188. doi：10.3389/fnins.2017.00188. PMID：28424581；PMCID：PMC5380729. [19]Janelidze S，Hertze J，Nägga K，Nilsson K，Nilsson C；Swedish BioFINDER Study Group，Wennström M，van Westen D，Blennow K，Zetterberg H，Hansson O. 2017 Mar；51：104-112. doi：10.1016/j.neurobiolaging.2016.11.017. Epub 2016 Dec 5. PMID：28061383；PMCID：PMC5754327. [20]Feinkohl I，Winterer G，Pischon T. Diabetes is associated with risk of postoperative cognitive dysfunction：A meta-analysis. Diabetes Metab Res Rev. 2017 Jul；33（5）. doi：10.1002/dmrr.2884. Epub 2017Feb 23. PMID：28063267. [21]Kobayashi K，Kitamura T，Kohira S，Torii S，Horai T，Hirata M，Mishima T，Sughimoto K，Ohkubo H，Irisawa Y，Matsushiro T，Hayashi H，Miyata Y，Tsuchida Y，Ohtomo N，Miyaji K. Factors associated with a low initial cerebral oxygen saturation value in patients undergoing cardiac surgery. J Artif Organs. 2017 Jun；20（2）：110-116. doi：10.1007/s10047-016-0941-6. Epub 2017 Jan 4. PMID：28054177. [22]Casati A，Fanelli G，Pietropaoli P，Proietti R，Tufano R，Danelli G，Fierro G，De Cosmo G，Servillo G；Collaborative Italian Study Group on Anesthesia in Elderly Patients. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg. 2005 Sep；101（3）：740-747. doi：10.1213/01.ane.0000166974.96219.cd. Erratum in：Anesth Analg. 2006 Jun；102（6）：1645. Fierro，Giovanni [corrected to Fierro，Giuseppe]. PMID：16115985. [23]Hirofumi O，Otone E，Hiroshi I，Satosi I，Shigeo I，Yasuhiro N，Masato S. The effectiveness of regional cerebral oxygen saturation monitoring using near-infrared spectroscopy in carotid endarterectomy. J Clin Neurosci. 2003 Jan；10（1）：79-83. doi：10.1016/s0967-5868（02）00268-0. PMID：12464528. [24]Shmigel'skiĭ AV，Lubnin AIu，Sazonova OB. Tserebral'naia oksimetriia u ne ĭrokhirurgicheskikh bol'nykh s sosudisto ĭ patologie ĭgolovnogo mozga. Chast' I. Analiz prichin intraoperatsionnoĭ dinamiki pokazatelia rSO2 i ee prognosticheskoe znachenie [Cerebral oximetry in neurosurgical patients with cerebrovascular diseases. I. Analysis of causes of intraoperative changes in rSO2 values and its prognostic significance]. Anesteziol Reanimatol. 2000 Jul-Aug；（4）：11-9. Russian. PMID：11013990. 王维嘉，张宁晨，张越伦，龚亚红.妇科腹腔镜手术中局部脑氧饱和度变化趋势及其相关因素定量分析[J].基础医学与临床，2021，41（07）：1039-1042.