Changs Of Regional Cerebral Oxygen Saturation In Patientens Undergoing Vale Repiacement Effects Of Chemotherapy On Postoperative Cognitive Function And Prognosis

Objective:To evaluate the effect of regional cerebral oxygen saturation（rSO₂）on postoperative cognitive function and prognosis by observing the changes of regional cerebral oxygen saturation（rSO₂）in patients undergoing valve replacement,so as to provide clinical evidence for the rational application of near infrared light（NIR）in monitoring rSO₂.Methods:Twenty-one patients（40-60 years old）undergoing cardiac valve replacement under cardiopulmonary bypass（CPB）were enrolled in this study.Their cardiac function was gradeⅡ-Ⅲand ASAⅡ-Ⅲ.Cerebral hypoxia was defined as rSO₂<50%or decreasing amplitude>20%before operation.Cerebral hypoxia occurred during operation was set as T group and no cerebral hypoxia was set as N group.After inhaling oxygen 6L/min under the rest of the room for 2 minutes,the rSO₂ value was set to record the entry T 0 before rSO₂,T 1 at 5 minutes after intubation,T 2 at the beginning of CPB,T 3 at rewarming,T 4 at jump-back,and T 5 at the end of cardiopulmonary bypass（CPB）.T6 HR at the end of surgery,MAP,SpO₂,nasopharynx temperature,anal temperature,bilateral rSO₂.MMSE was used to evaluate cognitive function before and on the3rd and 7th day after operation.Mechanical ventilation time,ICU stay time,postoperative hospitalization time and severe neurological complications（cerebral hemorrhage,cerebral infarction,coma）were recorded.New or aggravating epilepsy（Epilepsy）as a prognostic indicator.Results:There was no significant difference in the ratio of male to female,hypertension,age,preoperative cardiothoracic ratio and preoperative Hb between the two groups（P>0.05）,but the heart rate in group T was faster than that in group N at the beginning of cardiopulmonary bypass（P<0.05）.The rSO₂ in T group was lower than that in N group（P<0.05）.The mean duration of cerebral hypoxia was 14.12±17.65 min,and the incidence of POCD in group T was higher than that in group N on the 7th day after operation（P<0.05）.The duration of mechanical ventilation in group T was longer than that in group N（P<0.05.The mean duration of mechanical ventilation in group T was longer than that in group N（P<0.05）.The correlation analysis between rSO₂ and MAP showed that there was a positive correlation between rSO₂ and MAP（r=0.78）,P<0.05）.Conclusion:the rSO₂<50%or the decrease range>20%in patients undergoing valve replacement under cardiopulmonary bypass is related to the occurrence of early postoperative POCD and prolongs the duration of mechanical ventilation after operation.