圍術(shù)期并發症||腦(nǎo)電(diàn)監測與術(shù)後谵妄

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圍術(shù)期并發症||腦(nǎo)電(diàn)監測與術(shù)後谵妄(圖1)

摘要(yào)譯文(wén)（供參考）

心髒手術(shù)中術(shù)中腦(nǎo)電(diàn)圖額葉∑±‍α波分(fēn)析與術(shù)後谵妄的(de)↑≈前瞻性隊列研究

背景：

術(shù)後谵妄（Postoperative deliri←¶ um，POD）仍然是(shì)心髒手術(shù→σ)後的(de)常見(jiàn)并發症，術(shù‌£♣>)前認知(zhī)狀态是(shì)主要(yào)誘發因素之一(yī)。然而，×δ₽進行(xíng)完整的(de)術(shù)前神經心∑β 理(lǐ)測試是(shì)具有(yǒu)挑戰性的(de)。全麻期間(₹ ¥•jiān)額葉腦(nǎo)電(diàn)圖（electroencep& >♦halographic，EEG）α波的(de)幅度與術(shù)前認™♠✘φ知(zhī)有(yǒu)關，可(kě)能(néng)™☆‌構成大(dà)腦(nǎo)易感性的(de✔α★☆)功能(néng)标志(zhì)。

目的(de)：

我們推測術(shù)中α-帶活性的(de♥ )特征可(kě)以預測POD的(de)發生(shēng)。

設計(jì)：單中心前瞻性觀察性研究。

實施：大(dà)學醫(yī)院，2019年(nián)¥δ♦5月(yuè)15日(rì)至2021年(nián)12月(yuè)15日(δ→÷₩rì)。

患者：接受擇期心髒手術(shù)的(de)成年(λ×nián)患者。

主要(yào)結局指标：

術(shù)前認知(zhī)狀态通(tōng)過神經心理(πγ‍lǐ)學測試進行(xíng)評估，并作(zuò)為(wè∞εi)整體(tǐ)z評分(fēn)。

在麻醉誘導後30分(fēn)鐘(zhōng)獲得(de)5分(fēn)鐘(≈₹zhōng)的(de)腦(nǎo)電(diàn)圖記≠∑≥錄。

使用(yòng)七氟醚維持麻醉。

從(cóng)頻(pín)譜中提取出α波段的(de)功率和(hé)峰值頻(pí‍÷¥&n)率。

POD使用(yòng)重症監護室谵妄評估量表、谵妄評估÷σ€Ω量表和(hé)圖表審查進行(xíng)評估。

結果：

220例患者中有(yǒu)65例（29.5%）出現(xi'$♥₹àn)POD。

谵妄患者年(nián)齡明(míng)顯較大(dà) ✘¥★，中位[IQR]年(nián)齡為(wèi)74[64-79]歲 ★¥Vs 67[59-74]歲，P<0.001。

谵妄患者術(shù)前認知(zhī)z評分(fēn)較低(≥‍☆dī)（-0.52±1.14 Vs.0.21±0.84； ✘P<0.001）。

谵妄患者的(de)平均α波功率（-14.↓₹δ♦03±4.61 dB Vs.-11.59±3.37 dB；P& >₩lt;0.001）和(hé)最大(dà)α功率（-11.36±5.28 d≤ ×B Vs.-8.85±3.90 dB；P<0.001）顯著降↔ ★低(dī)。

術(shù)中平均α波功率與POD發生(s>✘←hēng)的(de)概率顯著相(xiàng)λ• ¥關（調整比值比，0.88；95%置信區(qū)間(jiān)（con ♥fidence interval，CI），0.&β↕$81至0.96；P=0.007）。

僅在不(bù)考慮認知(zhī)狀态的(de)情況下(xià)&"÷ε，術(shù)中平均α波功率與年(nián)齡無關→γ™。

結論：

心髒手術(shù)後，術(shù)中額葉α波功率較低(dī)與POD發生(©♦¥¥shēng)率較高(gāo)有(yǒu)關。術(s↔‌hù)中α波功率的(de)測量可(kě)以作(zuò)為(wèi)識别有 ↕δ♣(yǒu)這(zhè)種并發症風(fēng)險的( ↕δde)患者的(de)一(yī)種手段。

原文(wén)摘要(yào)

Intra-operative electroencephalogram ↔®≠frontal alpha-band spectral anal←∏₽ysis and postoperative delirium i±←n cardiac surgery: A€>™ prospective cohort study

Background:Postoperative delirium ( 'POD) remains a frequent compli£ ★cation after cardiac sur♠∑ ×gery, with pre-operative cognitivε←e status being one of ≠≥← the main predisposing fac ¶✘tors. However, performing comple<∞↕te pre-operative neuropsych<♠'ological testing is chal↔•✘lenging. The magnitude ₩∑↕©of frontal electroencephaφ☆♥lographic (EEG) α oscillations du≠ ™ring general anaesth←•esia has been related to pre-operative≥> cognition and could consφ≥titute a functional marker for brain∞‌ vulnerability.

Objective:We hypothesised that feature↔≠π¥s of intra-operative α→α-band activity could predict the o∞αΩ®ccurrence of POD.

Design:Single-centre prospective obserΩΩ≤vational study.

Setting:University hospital, from 15♦↓±£ May 2019 to 15 Decemπ ber 2021.

Patients:Adult patients undergoin'αg elective cardiac surgery.$∑↓™

Main outcome measures:Pre-operative cognitive status was✘β☆• assessed by neuropsychological§" tests and scored as a global z score.® ♥ A 5-min EEG recording was ≈★→obtained 30 min after induction o×€↓∞f anaesthesia. Anaesthesia wa ✔s maintained with sevofl€‍urane. Power and peak frequency in ↓¶✔the α-band were extracte$≈d from the frequency spect♥≤±ra. POD was assessed using the ♠¶ >Confusion Assessment ±₹Method for Intensive Care™'♠ Unit, the Confusion As∏ε☆ sessment Method and a chart review÷→α≈.

Results:Sixty-five (29.5%) of ↔><÷220 patients developed PO"®‌ D. Delirious patients were signif✔icantly older with media>₹n [IQR] ages of 74 [64 to ε ∏79] years vs. 67 [59 to ≠≥≤74] years; P < 0.001) and hδ‌₩←ad lower pre-operative cognitiv→↕e z scores (-0.52 ± 1.14 ÷÷αvs. 0.21 ± 0.84; P < 0.001)÷∏₹. Mean α power (-14.03 ± 4.61 dB♥<≥ vs. -11.59 ± 3.37 dB; P×π← < 0.001) and max≤∏εimum α power (-11.36 ± 5.28 dBσ✔↓ vs. -8.85 ± 3.90 dB; P < 0.001) wer↕<♦e significantly lower in ✘↔εdelirious patients. Intra-operative me✘'an α power was significantly assocε¶™§iated with the probability↓φ of developing POD (aα ←δdjusted odds ratio, 0.88; 95% cβ↓onfidence interval (♦≥CI), 0.81 to 0.96; P = 0.007), indepen∞§€dently of age and only wheneve↕↕λr cognitive status was nα§ot considered.

Conclusion:A lower intra-operative fron ★tal α-band power is associatα"ed with a higher incidence of ∏×POD after cardiac surger×γy. Intra-operative measu₹←res of α power could co₩$γ nstitute a means of ₩α✔identifying patients at♦→ risk of this complicatio↑≤βΩn.

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