大手术后麻醉深度和谵妄：一项随机临床试验

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大手术后麻醉深度和谵妄：一项随机临床试验

贵州医科大学 麻醉与心脏电生理课题组

翻译：牛振瑛    编辑：潘志军    审校：曹莹

背景 

术后谵妄是与长期住院，长期认知功能下降和死亡率相关的严重手术并发症。本研究旨在确定目标脑电双频指数（BIS）值为50（浅麻醉）的患者POD发生率是否比目标脑电双频指数（BIS）值为35（深麻醉）的患者低。

方法 

这项多中心随机临床试验对来自3个国家、8个中心的655名接受大手术的高危患者进行了评估，使用3分钟混淆评估方法(3D-CAM)或CAM-ICU评估术后5天内的谵妄情况，使用简易智力状态检查筛查患者入院时和出院时的认知状态，简易精神测试评分(AMTS)进行30天和1年时认知筛查。患者被分成浅麻醉或深麻醉。主要结果是术后前5天的任何一天出现了术后精神错乱。次要结果包括1年内死亡率、出院时认知能力下降、30天和1年内认知功能受损、计划外入ICU、住院时间和脑电爆发抑制时间。

结果 

BIS=50组和BIS=35组术后妄想发生率分别为19%和28%(OR 0.58 [95%CI: 0.38-0.88]。在术后1年时，BIS=50组的认知功能明显好于BIS=35组（AMT≤6时9% vs 20%；P<0.001）。

结论

在接受大手术的患者中，浅麻醉可降低术后1年时谵妄和认知障碍的风险。

原始文献来源

Evered LA, Chan MTV, Han R, et, al. Anaesthetic depth and delirium after major surgery: a randomised clinical trialBr J Anaesth. 2021 Nov;127(5):704-712.  doi: 10.1016/j. bja. 2021.07.021.  Epub 2021 Aug 28

英文原文 Anaesthetic depth and delirium after major surgery: a randomised clinical trial 

Background 

Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia).

Methods     

This multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary out-comes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression.

Results     

The incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38-0.88]; P=0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS≤6 vs 20%; P<0.001).

Conclusions   

Among patients undergoing major surgery, targeting light anaesthesia reduced the risk of postoperative delirium and cognitive impairment at 1 yr.