Shi Xinhua, Chen Xiangnan, Ni Jun, Zhang Yanqing, Liu Hui, Xu Chuan, Wang Hao
Department of Anesthesiology, Nanjing Gaochun People's Hospital, Nanjing, China.
Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China.
Ann Transl Med. 2022 Feb;10(4):186. doi: 10.21037/atm-22-90.
To study the effect of Narcotrend monitoring on the incidence of early postoperative cognitive dysfunction (POCD) under different Bispectral Index (BIS) conditions and the effect of different depths of anesthesia on the incidence of POCD.
We performed a literature search of the PubMed, Embase, OVID (database system made by Ovid Technologies, USA), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP Chinese Sci-tech Journals Database, Wanfang Data, etc. from the date of establishment of the database until December 31, 2020.
In the end, eighty articles were included, with a total of 714 patients. The meta-analysis results showed that four articles (255 patients) compared the state of deep anesthesia (BIS 30-40) with conventional anesthesia (BIS 40-60 earlier) after POCD. Also, the incidence of POCD on the first day after deep anesthesia [Narcotrend stage (NTS): negative correlation is currently the most appropriate egg description; Nd can subdivide the original electroencephalogram (EEG) into six stages 15 levels (Nd Sg, NTS), or A (state of wakefulness), state B0-B2 (sedated state), state C0-C2 (light anesthetic state), state D0-D2 (general anesthesia), state E0-E2 (deep anesthesia state), and state F0-F2 (burst suppression state)] was significantly lower than that of conventional anesthesia (NTS D0-D1) [odds ratio (OR) =0.21, 95% confidence interval (CI): 0.13-0.35, P<0.00001]. Moreover, the incidence of POCD in deep anesthesia (NTS E1) at 7 days after surgery was significantly lower than that of conventional anesthesia (NTS D0) (OR =0.45, 95% CI: 0.23-0.91, P=0.03), while the incidence of POCD 7 days after NTS D2 in conventional anesthesia was significantly lower than that of NTS D0 (OR =0.42, 95% CI: 0.24-0.71, P=0.001).
POCDs are thought to be the result of a combination of physical defects and precipitating factors in patients with their own physical impairments, and despite potential adverse effects, there is currently no consensus on the incidence of POCDs in patients with tumor, current risk factors, causes, and prevention strategies. Moreover, the level of evidence is low, and the deviation between different studies cannot be ruled out.
研究脑电双频指数（BIS）不同条件下脑电意识深度监测（Narcotrend）对术后早期认知功能障碍（POCD）发生率的影响以及不同麻醉深度对POCD发生率的影响。
我们检索了PubMed、Embase、OVID（美国Ovid Technologies公司的数据库系统）、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普中文科技期刊数据库、万方数据等数据库，检索时间从数据库建立至2020年12月31日。
最终纳入80篇文章，共714例患者。Meta分析结果显示，4篇文章（255例患者）比较了POCD后深度麻醉状态（BIS 30 - 40）与传统麻醉（早期BIS 40 - 60）。此外，深度麻醉后第1天POCD的发生率[脑电意识深度监测（NTS）：负相关是目前最合适的描述；Nd可将原始脑电图（EEG）细分为6个阶段15个水平（Nd Sg，NTS），或A（清醒状态）、B0 - B2状态（镇静状态）、C0 - C2状态（浅麻醉状态）、D0 - D2状态（全身麻醉）、E0 - E2状态（深度麻醉状态）和F0 - F2状态（爆发抑制状态）]显著低于传统麻醉（NTS D0 - D1）[比值比（OR）=0.21，95%置信区间（CI）：0.13 - 0.35，P<0.00001]。而且，术后7天深度麻醉（NTS E1）时POCD的发生率显著低于传统麻醉（NTS D0）（OR =0.45，95% CI：0.23 - 0.91，P =0.03），而传统麻醉中NTS D2后7天POCD的发生率显著低于NTS D0（OR =0.42，95% CI：0.24 - 0.71，P =0.001）。
POCD被认为是患者自身身体缺陷与诱发因素共同作用的结果，尽管存在潜在不良影响，但目前对于肿瘤患者POCD的发生率、当前危险因素、病因及预防策略尚无共识。此外，证据水平较低，无法排除不同研究之间的偏差。
