Correlation of Intraoperative Regional Brain Oxygen Saturation and Nerve Damage Markers with Postoperative Emergence Agitation/Delirium in Children Undergoing Open Heart Surgery Under Cardiopulmonary Bypass

XIE Yaxian; ZHONG Wei; ZHOU Junhui

doi:10.3969/j.issn.1004-437X.2025.21.008

Abstract：Objective To explore the correlation between intraoperative regional brain oxygen saturation(rSO2 C)and nerve damage markers and postoperative emergence agitation/delirium(POED)in children undergoing open heart surgery under cardiopulmonary bypass(CPB).Methods This study enrolled 60 pediatric patients scheduled for elective ventricular septal defect repair under CPB at Henan Provincial Chest Hospital from September 2023 to December 2024.All patients were classified as American Society of Anesthesiologists(ASA)physical status Ⅱ-Ⅲ,with an age range of 11 months to 14 years and a weight range of 9.8-21.4 kg.rSO2C was dynamically monitored intraoperatively using near-infrared spectroscopy(NIRS).Central venous blood samples were collected at five time points:10 minutes before anesthesia induction(T0),immediately after CPB initiation(T,),at CPB weaning(T2),at the end of surgery(T3),and upon ICU discharge(T4).Serum levels of S100 calcium-binding protein β(S100β)protein and neuron-specific enolase(NSE)were measured from these samples.The evaluation of pediatric delirium after anesthesia(POED)was performed by the POED rating scale after operation.The primary end point was POED.The intraoperative rSO2C value and the serum S100β protein and NSE concentrations were compared between the POED group and the NPOED group.The risk factors of POED and its correlation with the intraoperative rSO2C,serum S100β protein and NSE concentration was analyzed.Results A total of 19 children(31.7％)developed POED after surgery(POED group),and 41 children(68.3％)did not develop POED(NPOED group).Compared with the NPOED,the minimum mean arterial pressure during CPB and the minimum rSO2C during CPB were reduced(P＜0.05),the maximum difference between arterial and regional cerebral oxygen saturation(da-rSO2 C)during CPB was increased(P＜0.05),and duration of da-rSO2C＞50％during CPB,duration of da-rSO2C＞40％during CPB,duration of rSO2C reduction＞25％,rSO2C＜50％during CPB,rSO2C＜40％during CPB,duration of da-rSO2C＞50％during CPB and duration of da-rSO2C＞40％during CPB were prolonged(P＜0.05)in the POED group.At T1-4,the levels of serum S100β and NSE in POED group were higher,compared with NPOED group.Multivariate logistic regression analysis revealed that the duration of rSO2C decrease＞25％during cardiopulmonary bypass(CPB)(P=0.031),the duration of rSO2C＜40％(P=0.006),the duration of da-rSO2C(difference in bilateral regional cerebral oxygen saturation)＞50％(P=0.001),as well as serum NSE concentrations at T,to T4(with P values of 0.027,0.024,0.020,and 0.015,respectively)and S100β concentrations at T,to T4(with P values of 0.025,0.020,0.014,and 0.011,respectively)were all independent risk factors for the occurrence of POED.Conclusion The duration of a＞25％decrease in rSO2C,the duration of rSO2C＜40％,the duration of da-rSO2C＞50％during CPB,and elevated serum concentrations of NSE and S100β protein are independent risk factors for the occurrence of POED in pediatric patients.Continuous monitoring of intraoperative rSO2C and dynamic changes in postoperative serum neuronal injury markers facilitates early identification of children at high risk for POED and provides a basis for developing perioperative neuroprotective strategies.