心脏手术中术中脑电图额区阿尔法频段谱分析与术后谵妄：一项前瞻性队列研究。

Intra-operative electroencephalogram frontal alpha-band spectral analysis and postoperative delirium in cardiac surgery: A prospective cohort study.

机构信息

From the Department of Anaesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain) (CK, CW, DK, MM), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain) (CK, AR, CW, DK, SM, GA, MM), Institute of Neuroscience (IoNS), Université catholique de Louvain (UCLouvain) (CK, CL, CW, AI, AM, MM), Department of Epidemiology and Biostatistics, Université catholique de Louvain (UCLouvain) (AR), Department of Cardiothoracic and Vascular Surgery, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain) (SM, GA), Department of Neurology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels (AI), Department of Anaesthesia and Intensive Care Medicine, Liège University Hospital (VB) and Anaesthesia and Peri-operative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium (VB).

出版信息

Eur J Anaesthesiol. 2023 Oct 1;40(10):777-787. doi: 10.1097/EJA.0000000000001895. Epub 2023 Aug 8.

DOI:10.1097/EJA.0000000000001895

PMID:37551153

Abstract

BACKGROUND

Postoperative delirium (POD) remains a frequent complication after cardiac surgery, with pre-operative cognitive status being one of the main predisposing factors. However, performing complete pre-operative neuropsychological testing is challenging. The magnitude of frontal electroencephalographic (EEG) α oscillations during general anaesthesia has been related to pre-operative cognition and could constitute a functional marker for brain vulnerability.

OBJECTIVE

We hypothesised that features of intra-operative α-band activity could predict the occurrence of POD.

DESIGN

Single-centre prospective observational study.

SETTING

University hospital, from 15 May 2019 to 15 December 2021.

PATIENTS

Adult patients undergoing elective cardiac surgery.

MAIN OUTCOME MEASURES

Pre-operative cognitive status was assessed by neuropsychological tests and scored as a global z score. A 5-min EEG recording was obtained 30 min after induction of anaesthesia. Anaesthesia was maintained with sevoflurane. Power and peak frequency in the α-band were extracted from the frequency spectra. POD was assessed using the Confusion Assessment Method for Intensive Care Unit, the Confusion Assessment Method and a chart review.

RESULTS

Sixty-five (29.5%) of 220 patients developed POD. Delirious patients were significantly older with median [IQR] ages of 74 [64 to 79] years vs. 67 [59 to 74] years; P < 0.001) and had lower pre-operative cognitive z scores (-0.52 ± 1.14 vs. 0.21 ± 0.84; P < 0.001). Mean α power (-14.03 ± 4.61 dB vs. -11.59 ± 3.37 dB; P < 0.001) and maximum α power (-11.36 ± 5.28 dB vs. -8.85 ± 3.90 dB; P < 0.001) were significantly lower in delirious patients. Intra-operative mean α power was significantly associated with the probability of developing POD (adjusted odds ratio, 0.88; 95% confidence interval (CI), 0.81 to 0.96; P = 0.007), independently of age and only whenever cognitive status was not considered.

CONCLUSION

A lower intra-operative frontal α-band power is associated with a higher incidence of POD after cardiac surgery. Intra-operative measures of α power could constitute a means of identifying patients at risk of this complication.

TRIAL REGISTRATION

NCT03706989.

摘要

背景

术后谵妄（POD）仍然是心脏手术后的常见并发症，术前认知状态是主要的易患因素之一。然而，进行完整的术前神经心理学测试具有挑战性。全身麻醉期间额部脑电图（EEG）α 振荡的幅度与术前认知有关，可能构成大脑脆弱性的功能标志物。

目的

我们假设术中 α 波段活动的特征可以预测 POD 的发生。

设计

单中心前瞻性观察性研究。

地点

大学医院，2019 年 5 月 15 日至 2021 年 12 月 15 日。

患者

择期心脏手术的成年患者。

主要观察指标

术前认知状态通过神经心理学测试评估，并作为全球 z 评分进行评分。麻醉诱导后 30 分钟获得 5 分钟 EEG 记录。使用七氟醚维持麻醉。从频谱中提取 α 波段的功率和峰值频率。使用 ICU 意识模糊评估方法、意识模糊评估方法和图表审查来评估 POD。

结果

220 例患者中 65 例（29.5%）发生 POD。谵妄患者年龄明显较大，中位数[IQR]年龄为 74 [64 至 79]岁比 67 [59 至 74]岁；P<0.001），术前认知 z 评分较低（-0.52±1.14 比 0.21±0.84；P<0.001）。平均 α 功率（-14.03±4.61 dB 比-11.59±3.37 dB；P<0.001）和最大 α 功率（-11.36±5.28 dB 比-8.85±3.90 dB；P<0.001）在谵妄患者中明显较低。术中平均α功率与发生 POD 的概率显著相关（调整后的优势比，0.88；95%置信区间（CI），0.81 至 0.96；P=0.007），独立于年龄，并且仅在不考虑认知状态时。