脑氧饱和度监测与术后苏醒延迟的相关性研究进展
Research Progress on the Correlation between Cerebral Oxygen Saturation Monitoring and Delayed Postoperative Awakening
摘要: 术后苏醒延迟(Delayed Postoperative Awakening)是全身麻醉或手术后患者未能在预期时间内恢复意识或清醒状态的临床问题，其危害包括神经功能损伤风险增加、术后加速康复(ERAS)受阻、医疗资源负担加重、长期神经认知影响及继发性并发症。术中局部脑氧饱和度(regional cerebral oxygen saturation, rSO2)监测技术基于近红外光谱(NIRS)，通过无创、实时评估脑氧供需平衡，可早期预警脑灌注不足和缺氧事件，为预测和干预术后苏醒延迟提供关键依据。本文系统综述了rSO2监测技术的原理、与苏醒延迟的相关性、其在心脏手术、腹腔镜手术及特殊人群(如老年、儿科、肥胖患者)中的应用价值，并探讨其局限性(如个体差异干扰、局部缺血分辨能力不足)及未来发展方向(多模态监测整合、动态阈值优化)。现有证据表明，rSO2监测结合定量脑电图(QEEG)等多参数分析，有望优化围手术期管理策略，改善患者预后。
Abstract: Delayed Postoperative Awakening is a clinical issue where patients fail to regain consciousness or achieve a state of alertness within the expected time frame after general anesthesia or surgery. Its adverse effects include increased risk of neurological damage, disruption of Enhanced Recovery After Surgery (ERAS) protocols, increased burden on medical resources, long-term neurocognitive impacts, and secondary complications. Intraoperative monitoring of regional cerebral oxygen saturation (rSO2), based on Near-Infrared Spectroscopy (NIRS), provides non-invasive, real-time assessment of the cerebral oxygen supply-demand balance. It can serve as an early warning for cerebral hypoperfusion and hypoxic events, offering crucial evidence for predicting and intervening in delayed postoperative awakening. This article systematically reviews the principles of rSO2 monitoring technology, its correlation with delayed awakening, and its application value in cardiac surgery, laparoscopic surgery, and specific patient populations(such as elderly, pediatric, and obese patients). It also discusses its limitations (such as interference from individual differences and insufficient ability to distinguish local ischemia) and future development directions (integration of multimodal monitoring and optimization of dynamic thresholds). Current evidence suggests that combining rSO2 monitoring with multi-parameter analyses, such as quantitative electroencephalography (QEEG), holds promise for optimizing perioperative management strategies and improving patient outcomes.
文章引用：孙浩楠, 张二飞, 兰忠平. 脑氧饱和度监测与术后苏醒延迟的相关性研究进展[J]. 临床医学进展, 2025, 15(6): 1070-1075. https://doi.org/10.12677/acm.2025.1561826

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