合并缺血性脑卒中患者术后谵妄与血压的关系

高 璐1, 李秀 华2, 王永 成1, 马艳 巍3
1.华北理工大学 河北省唐山市 064300；2.唐山市工人医院 河北省唐山市 064300；3.承德医学院 河北省承德市 067000

摘要

目的：术后谵妄（postoperative delirium，POD）是急性起病的、精神状态呈波动性的改变，主要特征为意识障碍和认知能力下降，发生在术后24～72 h居多。随着经济卫生条件的不断进步，在外科手术中，越来越多合并缺血性脑卒中的患者，缺血性脑卒中患者的大脑本身具有器质性病变，称之为脆弱大脑，其对麻醉药物格外的敏感，所以容易在麻醉状态下发生循环功能障碍。血压作为四大生命体征之一，是重要的围术期监测指标之一。术中血压变化影响患者的术后苏醒与预后。有研究者认为术中长期低血压是导致术后谵妄的原因之一[1]。然而缺血性脑卒中患者术后谵妄的发生与术中血压的关系尚未报导。本文就合并缺血性脑卒中患者术后谵妄与血压的关系进行综述。

关键词

术后谵妄；缺血性脑卒中；脆弱大脑；术中血压；低血压

参考

[1]Wachtendorf LJ，Azimaraghi O，Santer P，et al. Association Between Intraoperative Arterial Hypotension and Postoperative Delirium After Noncardiac Surgery：A Retrospective Multicenter Cohort Study. Anesth Analg. 2022 Apr 1；134（4）：822-833. [2]Liu CY，Gong N，Liu W. The Association Between Preoperative Frailty and Postoperative Delirium ： A Systematic Review and Meta-analysis. J Perianesth Nurs. 2022 Feb；37（1）：53-62.e1. [3]Otomo Sumi，Maekawa Kengo，Goto Tomoko，et al. Pre-existing cerebral infarcts as a risk factor for delirium after coronary artery bypass graft surgery[J]. Interactive cardiovascular and thoracic surgery，2013，17（5）：799-804. [4]Androsova G，Krause R，Winterer G，et al. Biomarkers of postoperative delirium and cognitive dysfunction. Front Aging Neurosci.2015，7：112. [5]韩永正，郭向阳.术后谵妄及其生物标志物的研究进展[J].临床麻醉学杂志 2019，35（11）：1136-1138. [6]Wan，Tiantian，et al. “Association of Carotid Plaque and SerumLipoprotein-Associated Phospholipase A2（LP-PLA2）with Postoperative Delirium in Geriatric Patients Undergoing Hip Replacement：A Prospective Cohort Study.”Medical science monitor：international medical journal of experimental and clinical research vol. 26 e927763. 14 Nov. 2020. [7]He R，Wang F，Shen H，et al. Association between increased neutrophil-to-lymphocyte ratio and postoperative delirium in elderly patients with total hip arthroplasty for hip fracture. BMC Psychiatry. 2020 Oct 7；20（1）：496. [8]Tanabe S，Mohanty R，Lindroth H，et al. Cohort study into the neural correlates of postoperative delirium：the role of connectivity and slow-wave activity. Br J Anaesth. 2020 Jul；125（1）：55-66. [9]Inoue R，Sumitani M，Ogata T，et al. Direct evidence of centralnervous system axonal damage in patients with postoperative delirium：A preliminary study of pNF-H as a promising serum biomarker. Neurosci Lett. 2017 Jul 13；653：39-44. [10]Kong D ， Luo W ， Zhu Z ， et al. Factors associated with post-operative delirium in hip fracture patients：what should we care. Eur J Med Res. 2022 Mar 12；27（1）：40. [11]Hughes CG，Boncyk CS，Culley DJ，et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analg，2020，130（6）：1572-1590. [12]Chang BP，Wira C，Miller J，et al. Neurology Concepts：Young Women and Ischemic Stroke-Evaluation and Management in the Emergency Department. Acad Emerg Med. 2018 Jan；25（1）：54-64. [13]马林，巢宝华，曹雷，等.2007-2017 年中国脑卒中流行趋势及特征分析[J].中华脑血管病杂志（电子版）2020，14（05），253-258D0I：10.11817/j.issn.1673-9248.2020.05.001. [14]Liu J，Zheng L，Cheng Y，et al. Trends in outcomes of patientswith ischemic stroke treated between 2002 and 2016：insights from a Chinese cohort. Circ Cardiovasc Qual Outcomes，2019，12（12）：e005610. [15]国家卫生健康委脑卒中防治工程委员会.中国脑卒中防治报告 2019.北京：人民卫生出版社，2020：175-176. [16]Zhao B，Chen X，Chen Q，et al. Intraoperative Hypotension and Related Risk Factors for Postoperative Mortality After Noncardiac Surgery in Elderly Patients：A Retrospective Analysis Report. Clin Interv Aging. 2021 Oct 1；16：1757-1767. [17]Li N，Kong H，Li SL，et al. Intraoperative hypotension is associated with increased postoperative complications in patients undergoing surgery for pheochromocytoma-paraganglioma：a retrospective cohort study. BMC Anesthesiol. 2020 Jun 12；20（1）：147. [18]Gschaidmeier A，Heimgärtner M，Schnaufer L，et al. Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies. Front Pediatr. 2021 May 31；9：660096. [19]De Heus RAA，Tzourio C，Lee EJL，et al. Association Between Blood Pressure Variability With Dementia and Cognitive Impairment：A Systematic Review and Meta-Analysis. Hypertension. 2021 Nov；78（5）：1478-1489. [20]Nave AH，von Eckardstein A. Is lipoprotein（a）a risk factor for ischemic stroke and venous thromboembolism? Clin Res Cardiol Suppl. 2019 Apr；14（Suppl 1）：28-32. [21]Roseborough AD，Saad L，Goodman M，et al. White matter hyperintensities and longitudinal cognitive decline in cognitively normal populations and across diagnostic categories：A meta-analysis，systematic review，and recommendations for future study harmonization. Alzheimers Dement. 2022 Mar 23. [22]Hamilton OKL，Backhouse EV，Janssen E，et al. Cognitive impairment in sporadic cerebral small vessel disease：A systematic review and meta-analysis. Alzheimers Dement. 2021 Apr；17（4）：665-685. [23]Van Veluw SJ，Shih AY，Smith EE，et al：Detection，risk factors，and functional consequences of cerebral microinfarcts. Lancet Neurol，2017；16（9）：730 40. [24]Kitsis P，Zisimou T，Gkiatas I，et al. Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty：A Narrative Review of the Literature. Life（Basel）. 2022 Feb 20；12（2）：314.