丙泊酚不影响心脏骤停后昏迷患者早期脑电图对预后的预测可靠性。
Propofol does not affect the reliability of early EEG for outcome prediction of comatose patients after cardiac arrest.
机构信息
Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
Department of Clinical Neurophysiology, Technical Medical Centre, University of Twente, Enschede, the Netherlands; Departments of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, the Netherlands.
出版信息
Clin Neurophysiol. 2019 Aug;130(8):1263-1270. doi: 10.1016/j.clinph.2019.04.707. Epub 2019 May 10.
OBJECTIVE
To quantify the effects of propofol on the EEG after cardiac arrest and to assess their influence on predictions of outcome.
METHODS
In a prospective multicenter cohort study, we analyzed EEG recordings within the first 72 h after cardiac arrest. At six time points, EEGs were classified as favorable (continuous background), unfavorable (generalized suppression or synchronous patterns with ≥50% suppression), or intermediate. Quantitative EEG included measures for amplitude, background continuity, dominant frequency, and burst-suppression amplitude ratio (BSAR). The effect of propofol on each measure was estimated using mixed effects regression.
RESULTS
We included 496 patients. The EEG after propofol cessation had no additional value over EEG-based outcome predictions during propofol administration at 12 h after cardiac arrest. Propofol was associated with decreased EEG amplitude, background continuity and dominant frequency, and increased BSAR. However, propofol did neither increase the chance of unfavorable EEG patterns (adjusted odds ratio (aOR) 0.95 per increase of 2 mg/kg/h, 95%-CI: 0.81-1.11) nor decrease the chance of favorable EEG patterns (aOR 0.98, 95%-CI: 0.89-1.09).
CONCLUSIONS
Propofol induces changes of the postanoxic EEG, but does not affect its value for the prediction of outcome.
SIGNIFICANCE
We confirm the reliability of EEG-based outcome predictions in propofol-sedated patients after cardiac arrest.
目的
量化心脏骤停后丙泊酚对脑电图（EEG）的影响，并评估其对预后预测的影响。
方法
在一项前瞻性多中心队列研究中，我们分析了心脏骤停后 72 小时内的 EEG 记录。在六个时间点，EEG 被分类为有利（连续背景）、不利（广泛抑制或同步模式，抑制≥50%）或中间。定量脑电图包括幅度、背景连续性、主导频率和爆发抑制幅度比（BSAR）的测量。使用混合效应回归估计丙泊酚对每种测量值的影响。
结果
我们纳入了 496 名患者。在心脏骤停后 12 小时内给予丙泊酚时，停止丙泊酚后 EEG 对基于 EEG 的预后预测没有额外价值。丙泊酚与 EEG 幅度、背景连续性和主导频率降低以及 BSAR 增加有关。然而，丙泊酚既没有增加不利 EEG 模式的机会（调整后的优势比（aOR）每增加 2mg/kg/h 增加 0.95，95%-CI：0.81-1.11），也没有降低有利 EEG 模式的机会（aOR 0.98，95%-CI：0.89-1.09）。
结论
丙泊酚诱导了缺氧后 EEG 的变化，但不影响其对预后预测的价值。
意义
我们证实了心脏骤停后接受丙泊酚镇静的患者基于 EEG 的预后预测的可靠性。
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