Intraoperative and postoperative characteristics.

Objective Postoperative delirium is a common complication after neurosurgery. The association between intraoperative hypotension and postoperative delirium in the neurosurgical population is unknown. Design This is a secondary analysis of a randomized controlled study Setting Adults scheduled for elective craniotomy under general anesthesia were included in 1 study center. Participants Of 260 patients, a total of 240 participants are included for final analysis after excluding patients without intraoperative blood pressure data. The primary outcome measures The primary outcome was the occurrence of delirium within the first 5 postoperative days, assessed with the Confusion Assessment Method or a 3-minute Diagnostic interview for the Confusion Assessment Method. Results A total of 240 patients were included (median age, 45 years), and 83(35%) patients experienced postoperative delirium. Curves of lowest mean arterial pressure versus stroke incidence suggested a threshold at 65 mmHg. There was no association between duration below 65 mm Hg and postoperative delirium (odds ratio, 1.01; 95% confidence interval, 0.96, 1.06). The odds ratio for duration below 65 mm Hg for 10 minutes was 1.03 (95% confidence interval, 0.97, 1.09) adjusted by history of hypertension, age > 45 yr, tumor volume, tumor type of glioma, preoperative Mini-Mental State Examination (MMSE) >26, and dexmedetomidine infusion which were all indicated the independent risk factors for delirium. Conclusions The current results could not indicate intraoperative hypotension of mean arterial pressure lower than 65 mmHg associated with delirium after frontotemporal brain tumor resection. Trial registration ClinicalTrials.gov NCT04674241## 研究目的 术后谵妄是神经外科术后常见并发症，目前神经外科患者术中低血压与术后谵妄的关联尚不明确。 ## 研究设计 本研究为一项随机对照研究的二次分析。 ## 研究场所 单中心纳入择期全身麻醉下行开颅手术的成年患者。 ## 研究对象 初始纳入260例患者，排除无术中血压数据者后，最终240例纳入最终分析。 ## 主要结局指标 主要结局指标为术后前5天内谵妄的发生情况，采用谵妄评定方法（Confusion Assessment Method, CAM）或谵妄评定法3分钟诊断访谈版进行评估。 ## 研究结果 最终纳入240例患者（年龄中位数为45岁），其中83例（35%）发生术后谵妄。最低平均动脉压与卒中发生率的曲线提示存在65mmHg的阈值。术中平均动脉压低于65mmHg的持续时长与术后谵妄无显著关联（比值比=1.01；95%置信区间：0.96~1.06）。在校正高血压病史、年龄>45岁、肿瘤体积、肿瘤类型为胶质瘤、术前简易精神状态检查表（Mini-Mental State Examination, MMSE）评分>26分以及右美托咪定输注这些谵妄的独立危险因素后，术中平均动脉压低于65mmHg持续10分钟的比值比为1.03（95%置信区间：0.97~1.09）。 ## 研究结论 本研究结果未显示额颞叶脑肿瘤切除术后患者术中平均动脉压低于65mmHg的低血压与术后谵妄存在关联。 ## 试验注册 ClinicalTrials.gov注册号：NCT04674241