[Factors affecting intraoperative changes in regional cerebral tissue oxygen saturation in elderly patients...

Objective: To explore the factors that affect the fluctuation of intraoperative regional cerebral oxygen saturation (rSctO₂) in elderly patients undergoing laparoscopic hysterectomy. Methods: A retrospective analysis of 39 elderly patients undergoing elective laparoscopic hysterectomy in Yale New Haven Hospital from October 2016 to February 2017 was performed. Factors including patients' demographic data, past medical history, intraoperative monitoring index and rSctO₂ index (baseline, maximum, minimum, maximum-baseline, baseline-minimum) were recorded. Pearson correlation analysis was used to analyze the correlation between rSctO₂ indexes and preoperative and intraoperative factors. Independent sample t-test was used to compare the differences of rSctO₂ indexes between hypertension group and the group without hypertension, as well as diabetes group and the group without diabetes. Taking diabetes as the stratification factor, the relationship between rSctO₂and factors including age, body mass index, hypertension were analyzed using multivariate analysis. Results: The age of the patients was (67.6±5.6) years old. The baseline value of rSctO₂ was (71.2±3.9)% in the left frontal lobe and (70.8±4.1)% in the right frontal lobe. Results from univariate analysis showed that the left and right maximum-baseline value of rSctO₂ were (12.9±4.5)% and (12.8±4.4)%, which were significantly lower than (16.3±4.2)% and (16.2±4.9)% in the group without hypertension (t=2.329, 2.266, all P<0.05). The right baseline-minimum in the group with hypertension was (5.3±3.7)%, which was significantly higher than (2.7±4.2)% in the group without hypertension (t=-2.061, P<0.05). The left minimum value of rSctO₂ in diabetic group was (64.4±4.2)%, and the maximum value of rSctO₂on the left and right sides were (81.7±4.0)% and (81.9±4.5)%, which were lower than (68.4±4.1)%, (86.7±4.2)% and (86.0±3.7)% in the group without diabetes (t=2.623, 3.297, 2.850, all P<0.05). The results of multivariate analysis showed the influence of age (t=2.866, P<0.05) and hypertension on left maximum-baseline (t=-4.530, P<0.01) was statistically significant. The influence of hypertension on right maximum-baseline was statistically significant (t=-4.629,P<0.01). Conclusion: Preoperative diabetes and hypertension are factors significantly affecting the intraoperative rSctO₂ of elderly patients with laparoscopic hysterectomy.