Li Na, Liu Xing, Gao Yuhua, Yin Lingzi, Zhao Wanli, Ma Rongxing, Ni Xinli
Department of Anaesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China.
Department of Neuroelectrophysiology, General Hospital of Ningxia Medical University, Yinchuan, China.
Front Surg. 2022 Sep 6;9:900122. doi: 10.3389/fsurg.2022.900122. eCollection 2022.
Delirium is a frequent and serious complication following cardiac surgery involving cardiopulmonary bypass (CPB). Electroencephalography reflects the electrical activity of the cerebral cortex. The impact of electroencephalographic epileptiform discharges during cardiac surgery on postoperative delirium remains unclear. This study was designed to investigate the relationship between intraoperative epileptiform discharges and postoperative delirium in patients undergoing cardiac surgery.
A total of 76 patients who underwent cardiac surgery under CPB were included. The baseline cognitive status was measured before surgery. Electroencephalograms were monitored continuously from entry into the operating room to the end of surgery. The presence of delirium was assessed through the Confusion Assessment Method or the Confusion Assessment Method for the Intensive Care Unit on the first 3 days after surgery. Univariate and multivariate logistic regression analyses were performed to evaluate the association between epileptiform discharges and delirium.
Delirium occurred in 31% of patients and epileptiform discharges were present in 26% of patients in the study. Patients with delirium had a higher incidence of epileptiform discharges (52.63% vs. 13.95%, < 0.001) and longer durations of anesthesia and CPB ( = 0.023 and = 0.015, respectively). In addition, patients with delirium had a longer length of hospital stay and a higher incidence of postoperative complications. Multivariate logistic regression analysis showed that age and epileptiform discharges were significantly associated with the incidence of postoperative delirium [odds ratio, 4.75 (1.26-17.92), = 0.022; 5.00 (1.34-18.74), = 0.017, respectively].
Postoperative delirium is significantly related to the occurrence of epileptiform discharges during cardiac surgery.
谵妄是心脏手术（包括体外循环（CPB））后常见且严重的并发症。脑电图反映大脑皮层的电活动。心脏手术期间脑电图癫痫样放电对术后谵妄的影响尚不清楚。本研究旨在调查心脏手术患者术中癫痫样放电与术后谵妄之间的关系。
共纳入76例接受CPB心脏手术的患者。术前测量基线认知状态。从进入手术室到手术结束持续监测脑电图。术后前3天通过意识模糊评估法或重症监护病房意识模糊评估法评估谵妄的发生情况。进行单因素和多因素逻辑回归分析以评估癫痫样放电与谵妄之间的关联。
本研究中31%的患者发生谵妄，26%的患者出现癫痫样放电。发生谵妄的患者癫痫样放电发生率更高（52.63%对13.95%，<0.001），麻醉和CPB持续时间更长（分别为=0.023和=0.015）。此外，发生谵妄的患者住院时间更长，术后并发症发生率更高。多因素逻辑回归分析显示，年龄和癫痫样放电与术后谵妄的发生率显著相关[比值比分别为4.75（1.26 - 17.92），=0.022；5.00（1.34 - 18.74），=0.017]。
术后谵妄与心脏手术期间癫痫样放电的发生显著相关。
