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Abstract：
BACKGROUND: Postoperative delirium (POD) represents a prevalent and noteworthy complication in the context of pediatric surgical interventions. In recent times, a hypothesis has emerged positing that cerebral ischemia and regional cerebral oxygen desaturation might serve as potential catalysts in the pathogenesis of POD. The primary aim of this study was to methodically examine the potential relationship between POD and regional cerebral oxygen saturation (rSO2) and to assess the predictive and evaluative utility of rSO2 in the context of POD.
METHODS: This prospective observational study was conducted at the Children\'s Hospital, Zhejiang University School of Medicine, Zhejiang, China, spanning the period from November 2020 to March 2021. The research cohort comprised children undergoing surgical procedures within this clinical setting. To measure rSO2 dynamics, cerebral near-infrared spectroscopy (NIRS) was used to monitor rSO2 levels both before and after surgery. In addition, POD was assessed in the paediatric patients according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. The analysis of the association between the rSO2 index and the incidence of POD was carried out through the application of either the independent samples t-test or the nonparametric rank-sum test. To ascertain the threshold value of the adjusted rSO2 index for predictive and evaluative purposes regarding POD in the pediatric population, the Receiver Operating Characteristics (ROC) curve was employed.
RESULTS: A total of 211 cases were included in this study, of which 61 (28.9%) developed POD. Participants suffering delirium had lower preoperative rSO2mean, lower preoperative rSO2min, and lower postoperative rSO2min, higher ∆rSO2mean, higher amount of ∆rSO2mean, lower ∆rSO2min (P < 0.05). Preoperative rSO2mean (AUC = 0.716, 95%CI 0.642-0.790), ∆rSO2mean (AUC = 0.694, 95%CI 0.614-0.774), amount of ∆rSO2mean (AUC = 0.649, 95%CI 0.564-0.734), preoperative rSO2min (AUC = 0.702, 96%CI 0.628-0.777), postoperative rSO2min (AUC = 0.717, 95%CI 0.647-0.787), and ∆rSO2min (AUC = 0.714, 95%CI 0.638-0.790) performed well in sensitivity and specificity, and the best threshold were 62.05%, 1.27%, 2.41%, 55.68%, 57.36%, 1.29%.
CONCLUSIONS: There is a close relationship between pediatric POD and rSO2. rSO2 could be used as an effective predictor of pediatric POD. It might be helpful to measure rSO2 with NIRS for early recognizing POD and making it possible for early intervention.
METHODS: This prospective observational study was conducted at the Children\'s Hospital, Zhejiang University School of Medicine, Zhejiang, China, spanning the period from November 2020 to March 2021. The research cohort comprised children undergoing surgical procedures within this clinical setting. To measure rSO2 dynamics, cerebral near-infrared spectroscopy (NIRS) was used to monitor rSO2 levels both before and after surgery. In addition, POD was assessed in the paediatric patients according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. The analysis of the association between the rSO2 index and the incidence of POD was carried out through the application of either the independent samples t-test or the nonparametric rank-sum test. To ascertain the threshold value of the adjusted rSO2 index for predictive and evaluative purposes regarding POD in the pediatric population, the Receiver Operating Characteristics (ROC) curve was employed.
RESULTS: A total of 211 cases were included in this study, of which 61 (28.9%) developed POD. Participants suffering delirium had lower preoperative rSO2mean, lower preoperative rSO2min, and lower postoperative rSO2min, higher ∆rSO2mean, higher amount of ∆rSO2mean, lower ∆rSO2min (P < 0.05). Preoperative rSO2mean (AUC = 0.716, 95%CI 0.642-0.790), ∆rSO2mean (AUC = 0.694, 95%CI 0.614-0.774), amount of ∆rSO2mean (AUC = 0.649, 95%CI 0.564-0.734), preoperative rSO2min (AUC = 0.702, 96%CI 0.628-0.777), postoperative rSO2min (AUC = 0.717, 95%CI 0.647-0.787), and ∆rSO2min (AUC = 0.714, 95%CI 0.638-0.790) performed well in sensitivity and specificity, and the best threshold were 62.05%, 1.27%, 2.41%, 55.68%, 57.36%, 1.29%.
CONCLUSIONS: There is a close relationship between pediatric POD and rSO2. rSO2 could be used as an effective predictor of pediatric POD. It might be helpful to measure rSO2 with NIRS for early recognizing POD and making it possible for early intervention.
摘要：
背景：手术后谵妄（POD）是儿科手术干预中普遍存在且值得注意的并发症。最近,已经出现了一个假设，认为脑缺血和局部脑氧去饱和可能是POD发病的潜在催化剂。这项研究的主要目的是系统地检查POD与区域脑氧饱和度（rSO2）之间的潜在关系，并评估在POD背景下rSO2的预测和评估效用。
方法：这项前瞻性观察研究在儿童医院进行，浙江大学医学院,浙江,中国,从2020年11月到2021年3月。研究队列包括在这种临床环境下接受外科手术的儿童。为了测量rSO2动力学，脑近红外光谱（NIRS）用于监测手术前后的rSO2水平。此外,根据《精神障碍诊断和统计手册第五版》（DSM-5）标准评估儿科患者的POD。通过应用独立样本t检验或非参数秩和检验，对rSO2指数与POD发生率之间的关联进行了分析。为了确定调整后的rSO2指数的阈值，以预测和评估儿科人群中的POD，采用接收器工作特性(ROC)曲线。
结果：本研究共纳入211例，其中61人（28.9%）发生POD。患有谵妄的参与者术前rSO2mean较低，降低术前rSO2min，并降低术后rSO2min，较高ΔrSO2平均值，较高的ΔrSO2平均值，降低ΔrSO2min(P<0.05)。术前rSO2平均值（AUC=0.716，95CI0.642-0.790），ΔrSO2平均值（AUC=0.694，95CI0.614-0.774），ΔrSO2平均值（AUC=0.649，95CI0.564-0.734），术前rSO2min（AUC=0.702，96CI0.628-0.777），术后rSO2min（AUC=0.717，95CI0.647-0.787），ΔrSO2min（AUC=0.714，95CI0.638-0.790）在灵敏度和特异性方面表现良好，最佳阈值为62.05%，1.27%，2.41%,55.68%,57.36%,1.29%。
结论：小儿POD与rSO2有密切关系。rSO2可作为小儿POD的有效预测因子。使用NIRS测量rSO2可能有助于早期识别POD并使其有可能早期干预。
方法：这项前瞻性观察研究在儿童医院进行，浙江大学医学院,浙江,中国,从2020年11月到2021年3月。研究队列包括在这种临床环境下接受外科手术的儿童。为了测量rSO2动力学，脑近红外光谱（NIRS）用于监测手术前后的rSO2水平。此外,根据《精神障碍诊断和统计手册第五版》（DSM-5）标准评估儿科患者的POD。通过应用独立样本t检验或非参数秩和检验，对rSO2指数与POD发生率之间的关联进行了分析。为了确定调整后的rSO2指数的阈值，以预测和评估儿科人群中的POD，采用接收器工作特性(ROC)曲线。
结果：本研究共纳入211例，其中61人（28.9%）发生POD。患有谵妄的参与者术前rSO2mean较低，降低术前rSO2min，并降低术后rSO2min，较高ΔrSO2平均值，较高的ΔrSO2平均值，降低ΔrSO2min(P<0.05)。术前rSO2平均值（AUC=0.716，95CI0.642-0.790），ΔrSO2平均值（AUC=0.694，95CI0.614-0.774），ΔrSO2平均值（AUC=0.649，95CI0.564-0.734），术前rSO2min（AUC=0.702，96CI0.628-0.777），术后rSO2min（AUC=0.717，95CI0.647-0.787），ΔrSO2min（AUC=0.714，95CI0.638-0.790）在灵敏度和特异性方面表现良好，最佳阈值为62.05%，1.27%，2.41%,55.68%,57.36%,1.29%。
结论：小儿POD与rSO2有密切关系。rSO2可作为小儿POD的有效预测因子。使用NIRS测量rSO2可能有助于早期识别POD并使其有可能早期干预。
