机械通气患者高谵妄风险的脑电图特征

机械通气患者高谵妄风险的脑电图特征

贵州医科大学     麻醉与心脏电生理课题组

翻译：柏雪  编辑：张中伟  审核：曹莹

罂 粟 摘 要  

背景：ICU谵妄的神经生理学研究有限。因此，我们研究了ICU的高危谵妄—ICU中新发意识状态改变的内科手术危重患者的脑电图特征。

方法：对接受前瞻性多中心随机对照EEG研究（NCT03129438，2017年4月至2018年11月）的非神经系统疾病且进行机械通气受试者进行预先计划分析。根据2012年ACNS命名法，EEG特征包括背景活动、节律周期模式/癫痫活动、振幅、频率、刺激诱发放电、三相波、反应性和NREM（非快眼动睡眠）。我们探讨了谵妄和非谵妄患者的脑电图特征，特别关注突发抑制和节律周期模式（发作-发作间期连续体）和发作活动的存在。

结果：我们分析了91名患者（中位年龄66岁），他们在入院后5天内因新发意识状态改变而接受脑电图检查；42例患者出现谵妄（46%）。谵妄患者的突发抑制(10% vs 0%, p = .02)、节律/周期性模式(43% vs 22%, p = .03)和癫痫样活动(7% vs 0%, p = .05)频率高于非谵妄的患者。至少一项异常脑电图发现(32/91患者; 35%)的存在与谵妄可能性的显著增加相关(42% vs 15%, p = .006)。两组之间镇静和镇痛药的累积剂量以及所有其他脑电图特征没有显著差异。

结论：在新发意识改变的机械通气非神经系统危重患者中，EEG显示突发抑制、节律或周期性模式，或癫痫发作/癫痫持续状态，表明ICU谵妄的风险增加。

原始文献来源：Elissavet Eskioglou， Carolina Iaquaniello， Vincent Alvarez et al. Electroencephalography of mechanically ventilated patients at high risk of delirium, Acta Neurol Scand. 2021;144:296–302.

英文原文   

Electroencephalography of mechanically ventilated patients at high risk of delirium

Abstract

Objective: Neurophysiological exploration of ICU delirium is limited. Here, we examined EEG characteristics of medical- surgical critically ill patients with new- onset altered consciousness state at high risk for ICU delirium.

Materials and methods: Pre- planned analysis of non- neurological mechanically ventilated medical- surgical ICU subjects, who underwent a prospective multicenter randomized, controlled EEG study (NCT03129438, April 2017– November 2018). EEG characteristics, according to the 2012 ACNS nomenclature, included background activity, rhythmic periodic patterns/epileptic activity, amplitude, frequency, stimulus- induced discharges, triphasic waves, reactivity, and NREM sleep. We explored EEG findings in delirious versus non- delirious patients, specifically focusing on the presence of burst- suppression and rhythmic periodic patterns (ictal- interictal continuum), and ictal activity.

Results: We analyzed 91 patients (median age, 66 years) who underwent EEG because of new- onset altered consciousness state at a median 5 days from admission; 42 patients developed delirium (46%). Burst- suppression (10 vs 0%, p = .02), rhythmic/periodic patterns (43% vs 22%, p = .03) and epileptiform activity (7 vs 0%, p = .05) were more frequent in delirious versus non- delirious patients. The presence of at least one of these abnormal EEG findings (32/91 patients; 35%) was associated with a significant increase in the likelihood of delirium (42 vs 15%, p = .006). Cumulative dose of sedatives and analgesics, as well as all other EEG characteristics, did not differ significantly between the two groups.

Conclusion: In mechanically ventilated non- neurological critically ill patients with new- onset alteration of consciousness, EEG showing burst- suppression, rhythmic or periodic patterns, or seizures/status epilepticus indicate an increased risk of ICU delirium.

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