脑电图生物标志物、脑氧饱和度与成年非心脏手术患者术后认知功能：一项前瞻性队列研究。
Electroencephalographic Biomarkers, Cerebral Oximetry, and Postoperative Cognitive Function in Adult Noncardiac Surgical Patients: A Prospective Cohort Study.
机构信息
Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan; Center for Consciousness Science, University of Michigan, Ann Arbor, Michigan.
Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan.
出版信息
Anesthesiology. 2023 Nov 1;139(5):568-579. doi: 10.1097/ALN.0000000000004664.
BACKGROUND
Perioperative neurocognitive disorders are a major public health issue, although there are no validated neurophysiologic biomarkers that predict cognitive function after surgery. This study tested the hypothesis that preoperative posterior electroencephalographic alpha power, alpha frontal-parietal connectivity, and cerebral oximetry would each correlate with postoperative neurocognitive function.
METHODS
This was a single-center, prospective, observational study of adult (older than 18 yr) male and female noncardiac surgery patients. Whole-scalp, 16-channel electroencephalography and cerebral oximetry were recorded in the preoperative, intraoperative, and immediate postoperative settings. The primary outcome was the mean postoperative T-score of three National Institutes of Health Toolbox Cognition tests-Flanker Inhibitory Control and Attention, List Sorting Working Memory, and Pattern Comparison Processing Speed. These tests were obtained at preoperative baseline and on the first two postoperative mornings. The lowest average score from the first two postoperative days was used for the primary analysis. Delirium was a secondary outcome (via 3-min Confusion Assessment Method) measured in the postanesthesia care unit and twice daily for the first 3 postoperative days. Last, patient-reported outcomes related to cognition and overall well-being were collected 3 months postdischarge.
RESULTS
Sixty-four participants were recruited with a median (interquartile range) age of 59 (48 to 66) yr. After adjustment for baseline cognitive function scores, no significant partial correlation (ρ) was detected between postoperative cognition scores and preoperative relative posterior alpha power (%; ρ = -0.03, P = 0.854), alpha frontal-parietal connectivity (via weight phase lag index; ρ = -0.10, P = 0.570, respectively), or preoperative cerebral oximetry (%; ρ = 0.21, P = 0.246). Only intraoperative frontal-parietal theta connectivity was associated with postoperative delirium (F[1,6,291] = 4.53, P = 0.034). No electroencephalographic or oximetry biomarkers were associated with cognitive or functional outcomes 3 months postdischarge.
CONCLUSIONS
Preoperative posterior alpha power, frontal-parietal connectivity, and cerebral oximetry were not associated with cognitive function after noncardiac surgery.
背景
围手术期神经认知障碍是一个主要的公共卫生问题，尽管目前还没有经过验证的神经生理生物标志物可以预测手术后的认知功能。本研究旨在验证假设，即术前后部脑电图阿尔法波功率、阿尔法额顶连接和脑氧饱和度与术后神经认知功能相关。
方法
这是一项单中心、前瞻性、观察性研究，纳入成年（年龄>18 岁）男性和女性非心脏手术患者。在术前、术中及术后即刻采集 16 通道全头皮脑电图和脑氧饱和度数据。主要结局为 NIH 工具包认知测试（Flanker 抑制控制和注意力、列表排序工作记忆和模式比较处理速度）的术后平均 T 评分。这些测试在术前基线和术后前两天的早晨进行。将术后前两天的最低平均得分用于主要分析。术后谵妄（通过 3 分钟意识模糊评估法）作为次要结局，在麻醉后恢复室测量，并在术后前 3 天每天测量两次。最后，在出院后 3 个月收集与认知和整体健康相关的患者报告结局。
结果
共纳入 64 名参与者，中位（四分位间距）年龄为 59（48 至 66）岁。在调整了基线认知功能评分后，术后认知评分与术前相对后部阿尔法波功率（%；ρ=-0.03，P=0.854）、阿尔法额顶连接（通过权重相位滞后指数；ρ=-0.10，P=0.570）或术前脑氧饱和度（%；ρ=0.21，P=0.246）之间均无显著的部分相关（ρ）。只有术中额顶叶θ连接与术后谵妄相关（F[1,6,291]=4.53，P=0.034）。术后认知或功能结局 3 个月时，无脑电图或血氧饱和度生物标志物与认知或功能结局相关。
结论
非心脏手术后，术前后部阿尔法波功率、额顶连接和脑氧饱和度与认知功能无关。
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