处理后的脑电图监测与术后谵妄：系统评价和荟萃分析。
Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis.
机构信息
From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California (K.K.M., J.M.L.) Department of Kinesiology, University of Indianapolis, Indianapolis, Indiana (A.M.B.-S.) Virginia Polytechnic Institute and State University, Center for Gerontology, Blacksburg, Virginia (L.P.S.).
出版信息
Anesthesiology. 2018 Sep;129(3):417-427. doi: 10.1097/ALN.0000000000002323.
WHAT WE ALREADY KNOW ABOUT THIS TOPIC
WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction.
METHODS
A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs.
RESULTS
Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76).
CONCLUSIONS
Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.
我们对该主题的已有了解
本文告诉我们的新内容：背景：术后谵妄在至少 65 岁的大手术患者中约占 15%至 20%，并与不良结局和资源利用增加有关。此外，患有术后谵妄的患者也可能有发展为长期术后认知功能障碍的风险。一个潜在的可改变的变量是使用术中处理的脑电图来指导麻醉。本系统评价和荟萃分析研究了处理脑电图监测与术后谵妄和认知功能障碍之间的关系。
方法
使用 Ovid MEDLINE、PubMed、EMBASE、Cochrane 图书馆和 Google 搜索，使用关键字处理脑电图、双频谱指数、术后谵妄、术后认知功能障碍，对随机对照试验进行了系统搜索。两名独立的审查员进行了筛选和数据提取，并评估了偏倚风险。采用固定效应模型计算的术后谵妄合并效应估计值表示为比值比及其 95%置信区间。
结果
从 369 个搜索结果中筛选出 13 项符合纳入标准。由于结局测量的异质性，排除了荟萃分析中的术后认知功能障碍数据；结果进行了描述性讨论。五项研究被纳入定量术后谵妄分析，共纳入 2654 例患者的数据。其中三项研究的偏倚风险较低，另外两项研究的偏倚风险不明确。使用处理脑电图指导麻醉与术后谵妄的发生风险降低 38%相关（比值比=0.62；P<0.001；95%置信区间，0.51 至 0.76）。
结论
处理脑电图指导麻醉与术后谵妄的发生减少有关。然而，解释这种关联的机制尚待确定。目前的数据不足以评估处理脑电图监测与术后认知功能障碍之间的关系。
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