Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction

摘要

Background: The objective of this prospective study is to determine cognitive dysfunction after thoracic surgery. Methods: Seventy-six patients undergoing thoracic surgery with single-lung ventilation (SLV) of an expected duration of 45 min were enrolled. Monitoring consisted of standard clinical parameters and absolute oximetry (S ctO 2). The Mini-Mental State Exam (MMSE) test was used to assess cognitive function before operation and at 3 and 24 h after operation. Data were analysed using Spearman correlation test; risks for cognitive dysfunction were expressed as odds ratios. P0.05 and data are presented as median (interquartile range). Results: One patient was excluded from the study. S ctO 2) during SLV decreased to critical values of 65%, 60%, and 55% in 40 (53%), 15 (20%), and 5 patients (7%), respectively. Twenty-two patients (29%) had a decrease of MMSE2 points 3 h after surgery, eight patients (10%) had a decrease of MMSE2 points 24 h after surgery. Postoperative cognitive dysfunction correlated at r 2=0.272, 0.285, 0.297 with patient exposure times to S ctO 2)65% (P=0.018), 60% (P=0.013), 55% (P=0.010), respectively. The odds ratios of developing early cognitive dysfunction ranged from 2.03 (95% CI: 0.74-5.59) for a short (5 min) exposure to S ctO 2)65% to a maximum of 9.56 (95% CI: 1.7552.13) when S ctO 2) was 60% for more than 30 min. Conclusions: Early cognitive dysfunction after thoracic surgery with SLV is positively related to intraoperative decline of S ctO 2).