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圍術(shù)期并發(fā)癥||腦電監(jiān)測(cè)與術(shù)后譫妄

以下文章來(lái)源于小麻哥的日常 ，作者兩只小綿羊


圍術(shù)期并發(fā)癥||腦電監(jiān)測(cè)與術(shù)后譫妄(圖1)



摘要譯文（供參考）

心臟手術(shù)中術(shù)中腦電圖額葉α波分析與術(shù)后譫妄的前瞻性隊(duì)列研究


背景：
術(shù)后譫妄（Postoperative delirium，POD）仍然是心臟手術(shù)后的常見(jiàn)并發(fā)癥，術(shù)前認(rèn)知狀態(tài)是主要誘發(fā)因素之一。然而，進(jìn)行完整的術(shù)前神經(jīng)心理測(cè)試是具有挑戰(zhàn)性的。全麻期間額葉腦電圖（electroencephalographic，EEG）α波的幅度與術(shù)前認(rèn)知有關(guān)，可能構(gòu)成大腦易感性的功能標(biāo)志。

目的：
我們推測(cè)術(shù)中α-帶活性的特征可以預(yù)測(cè)POD的發(fā)生。

設(shè)計(jì)：單中心前瞻性觀察性研究。

實(shí)施：大學(xué)醫(yī)院，2019年5月15日至2021年12月15日。

患者：接受擇期心臟手術(shù)的成年患者。

主要結(jié)局指標(biāo)：
術(shù)前認(rèn)知狀態(tài)通過(guò)神經(jīng)心理學(xué)測(cè)試進(jìn)行評(píng)估，并作為整體z評(píng)分。
在麻醉誘導(dǎo)后30分鐘獲得5分鐘的腦電圖記錄。
使用七氟醚維持麻醉。
從頻譜中提取出α波段的功率和峰值頻率。
POD使用重癥監(jiān)護(hù)室譫妄評(píng)估量表、譫妄評(píng)估量表和圖表審查進(jìn)行評(píng)估。

結(jié)果：
220例患者中有65例（29.5%）出現(xiàn)POD。
譫妄患者年齡明顯較大，中位[IQR]年齡為74[64-79]歲 Vs 67[59-74]歲，P<0.001。
譫妄患者術(shù)前認(rèn)知z評(píng)分較低（-0.52±1.14 Vs.0.21±0.84；P<0.001）。
譫妄患者的平均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）顯著降低。
術(shù)中平均α波功率與POD發(fā)生的概率顯著相關(guān)（調(diào)整比值比，0.88；95%置信區(qū)間（confidence interval，CI），0.81至0.96；P=0.007）。
僅在不考慮認(rèn)知狀態(tài)的情況下，術(shù)中平均α波功率與年齡無(wú)關(guān)。

結(jié)論：
心臟手術(shù)后，術(shù)中額葉α波功率較低與POD發(fā)生率較高有關(guān)。術(shù)中α波功率的測(cè)量可以作為識(shí)別有這種并發(fā)癥風(fēng)險(xiǎn)的患者的一種手段。


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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