围术期并发症||脑电监测与术后谵妄

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

心脏手术中术中脑电图额叶α波分析与术后谵妄的前瞻性队列研究

背景： 术后谵妄（Postoperative delirium，POD）仍然是心脏手术后的常见并发症，术前认知状态是主要诱发因素之一。然而，进行完整的术前神经心理测试是具有挑战性的。全麻期间额叶脑电图（electroencephalographic，EEG）α波的幅度与术前认知有关，可能构成大脑易感性的功能标志。

目的： 我们推测术中α-带活性的特征可以预测POD的发生。

设计：单中心前瞻性观察性研究。

实施：大学医院，2019年5月15日至2021年12月15日。

患者：接受择期心脏手术的成年患者。

主要结局指标：   术前认知状态通过神经心理学测试进行评估，并作为整体z评分。 在麻醉诱导后30分钟获得5分钟的脑电图记录。 使用七氟醚维持麻醉。 从频谱中提取出α波段的功率和峰值频率。 POD使用重症监护室谵妄评估量表、谵妄评估量表和图表审查进行评估。

结果： 220例患者中有65例（29.5%）出现POD。 谵妄患者年龄明显较大，中位[IQR]年龄为74[64-79]岁 Vs 67[59-74]岁，P<0.001。 谵妄患者术前认知z评分较低（-0.52±1.14 Vs.0.21±0.84；P<0.001）。

谵妄患者的平均α波功率（-14.03±4.61 dB Vs.-11.59±3.37 dB；P<0.001）和最大α功率（-11.36±5.28 dB Vs.-8.85±3.90 dB；P<0.001）显著降低。 术中平均α波功率与POD发生的概率显著相关（调整比值比，0.88；95%置信区间（confidence interval，CI），0.81至0.96；P=0.007）。 仅在不考虑认知状态的情况下，术中平均α波功率与年龄无关。

结论： 心脏手术后，术中额叶α波功率较低与POD发生率较高有关。术中α波功率的测量可以作为识别有这种并发症风险的患者的一种手段。

原文摘要

Intra-operative electroencephalogram frontal alpha-band spectral analysis and postoperative delirium in cardiac surgery: A prospective cohort study

Background:Postoperative delirium (POD) remains a frequent complication after cardiac surgery, with pre-operative cognitive status being one of the main predisposing factors. However, performing complete pre-operative neuropsychological testing is challenging. The magnitude of frontal electroencephalographic (EEG) α oscillations during general anaesthesia has been related to pre-operative cognition and could constitute a functional marker for brain vulnerability.

Objective:We hypothesised that features of intra-operative α-band activity could predict the occurrence of POD.

Design:Single-centre prospective observational study.

Setting:University hospital, from 15 May 2019 to 15 December 2021.

Patients:Adult patients undergoing elective cardiac surgery.

Main outcome measures:Pre-operative cognitive status was assessed by neuropsychological tests and scored as a global z score. A 5-min EEG recording was obtained 30 min after induction of anaesthesia. Anaesthesia was maintained with sevoflurane. Power and peak frequency in the α-band were extracted from the frequency spectra. POD was assessed using the Confusion Assessment Method for Intensive Care Unit, the Confusion Assessment Method and a chart review.

Results:Sixty-five (29.5%) of 220 patients developed POD. Delirious patients were significantly older with median [IQR] ages of 74 [64 to 79] years vs. 67 [59 to 74] years; P < 0.001) and had lower pre-operative cognitive z scores (-0.52 ± 1.14 vs. 0.21 ± 0.84; P < 0.001). Mean α power (-14.03 ± 4.61 dB vs. -11.59 ± 3.37 dB; P < 0.001) and maximum α power (-11.36 ± 5.28 dB vs. -8.85 ± 3.90 dB; P < 0.001) were significantly lower in delirious patients. Intra-operative mean α power was significantly associated with the probability of developing POD (adjusted odds ratio, 0.88; 95% confidence interval (CI), 0.81 to 0.96; P = 0.007), independently of age and only whenever cognitive status was not considered.

Conclusion:A lower intra-operative frontal α-band power is associated with a higher incidence of POD after cardiac surgery. Intra-operative measures of α power could constitute a means of identifying patients at risk of this complication.

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文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiLu.米鹭

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