阻塞性睡眠呼吸暂停患者术前缺氧生物标志物和术后谵妄。

IF 2.8 3区 医学 Q2 ANESTHESIOLOGY Journal of Anesthesia Pub Date : 2024-11-04 DOI:10.1007/s00540-024-03417-2
Martin Breitkopf, Elena Ahrens, Matthias L Herrmann, Stephanie Heinemann, Olivia Kuester, Haobo Ma, Andreas Walther, Christine Thomas, Gerhard W Eschweiler, Christine A F von Arnim, Soeren Wagner
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引用次数: 0

摘要

目的:阻塞性睡眠呼吸暂停(OSA)患者术后谵妄(POD)与死亡率和医疗费用的增加有关。在这项研究中,我们调查了 OSA 风险、中枢神经缺血的血清生物标志物(S100B 和 NSE)与 POD 的关联:研究伦理批准后,患者在接受择期手术前完成 STOP BANG 评估。在入院时和术后出院时分别抽血进行 S100B 和 NSE 测量,并使用蒙特利尔认知评估(MoCA)测试认知能力。谵妄评估采用护理谵妄筛查量表(NuDESC)和意识模糊评估法(CAM)进行:根据 STOP BANG 评分测试结果,124 名入选患者被分为三个 OSA 风险组(低风险,22 人;中度风险,67 人;高度风险,35 人)。术前 NSE 值随 OSA 风险的增加而增加(NSE 单位为 ng/ml;平均值 [范围];低风险:15.6 [9.2-44.3];中度风险:21.8 [7.6-114.1];高度风险:29.2 [10.1-151];P = 0.039)。术后 MoCA 和 NuDESC 评估结果在 OSA 风险组之间没有差异。我们发现随着 OSA 风险的增加,POD 的发生率也在降低(阳性 CAM:低风险:18.1%;中度风险:12.0%;高度风险:11.5%,p = 0.043)。然而,在完整病例分析中已无法检测到这一点。在POD患者中,不同OSA风险组的术后缺血性生物标志物值没有差异:我们发现随着 OSA 风险的增加,POD 发生率呈下降趋势,但在完整病例分析中这一趋势并不明显。我们的结果可能支持缺氧预处理现象。
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Preoperative hypoxic biomarkers and postoperative delirium in patients with obstructive sleep apnea.

Purpose: Postoperative delirium (POD) in patients with obstructive sleep apnea (OSA) is associated with increased mortality and healthcare costs. In this study, we investigated the association of OSA risk, serum biomarkers for central nervous ischemia (S100B and NSE), and POD.

Methods: After research ethics approval, patients completed the STOP BANG assessment before undergoing elective surgery. Blood was drawn for S100B and NSE measurement, and cognitive performance was tested using the Montreal Cognitive Assessment (MoCA) at study admission and postoperatively at discharge. Delirium assessment was performed using the Nursing Delirium Screening Scale (NuDESC) and the Confusion Assessment Method (CAM).

Results: One hundred twenty-four enrolled patients were separated into three OSA-risk groups based on STOP BANG score testing (low risk, n = 22; intermediate risk, n = 67; high risk, n = 35). Preoperative NSE values increased with OSA risk (NSE in ng/ml; mean [range]; low risk: 15.6 [9.2-44.3]; intermediate risk: 21.8 [7.6-114.1]; high risk: 29.2 [10.1-151]; p = 0.039). Postoperative MoCA and NuDESC assessments were not different between the OSA-risk groups. We found a decreasing incidence for POD with increasing OSA risk (positive CAM: low risk: 18.1%, intermediate risk: 12.0%; high risk: 11.5%, p = 0.043). However, this was no longer detectable in a complete case analysis. In patients with POD, postoperative ischemic biomarker values were not different between OSA-risk groups.

Conclusion: We found a trend of decreasing POD incidence with increasing OSA risk, which was not robust in a complete case analysis. Our results possibly support the phenomenon of hypoxic preconditioning.

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来源期刊
Journal of Anesthesia
Journal of Anesthesia 医学-麻醉学
CiteScore
5.30
自引率
7.10%
发文量
112
审稿时长
3-8 weeks
期刊介绍: The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite. The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.
期刊最新文献
Ultrasound assessment of the frequency and variation of arteries in the interscalene region. Preoperative hypoxic biomarkers and postoperative delirium in patients with obstructive sleep apnea. Reply to a letter. Effect of use of cuffed endotracheal tubes on the occurrence of postoperative extubation-related respiratory adverse events in pediatric patients with airway hypersensitivity: a retrospective cohort study. New insights in cardiovascular anesthesia: a dual focus on clinical practice and research.
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