麻醉剂量调整的术中脑电图α波功率、处理速度与术后谵妄之间的关联：三项前瞻性研究的数据分析
Associations between anaesthetic dose-adjusted intraoperative EEG alpha power, processing speed, and postoperative delirium: analysis of data from three prospective studies.
作者信息
Reese Melody, Wright Mary Cooter, Roberts Ken C, Browndyke Jeffrey N, Bennett Micheal, Acker Leah, Devinney Michael J, Reekes Tyler H, Waligorska Teresa, Shaw Leslie M, Blennow Kaj, Zetterberg Henrik, Cohen Harvey J, Mathew Joseph P, Whitson Heather E, Westover M Brandon, Woldorff Marty G, Berger Miles
机构信息
Department of Anaesthesiology, Duke University Medical Center, Durham, NC, USA; Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA, USA.
Department of Anaesthesiology, Duke University Medical Center, Durham, NC, USA.
出版信息
Br J Anaesth. 2025 Jul;135(1):109-120. doi: 10.1016/j.bja.2024.12.041. Epub 2025 Apr 11.
BACKGROUND
We previously have shown that low intraoperative EEG alpha power is associated with impaired preoperative cognition, a delirium risk factor, and that intraoperative anaesthetic-dose-adjusted EEG bispectral index values were associated with a four-fold increased risk of postoperative delirium (POD). Yet, associations between intraoperative anaesthetic-dose-adjusted alpha power and delirium or delirium risk factors have yet to be quantified.
METHODS
We examined cerebrospinal fluid (CSF) Alzheimer's disease (AD)-related biomarkers, cognitive scores, EEG recordings, and delirium data from 82 noncardiac, non-neurologic surgical patients ≥60 yr in age. Based on prior work, each participant's intraoperative frontoparietal EEG alpha power was anaesthetic dose-adjusted by dividing it by (2.5 minus the age-adjusted end-tidal minimum alveolar concentration), and then analysed for its association with POD and delirium risk factors, preoperative CSF AD-related biomarkers, and preoperative cognition.
RESULTS
Lower anaesthetic-dose-adjusted frontoparietal alpha power was associated with increased odds of POD (odds ratio [95% confidence interval (CI)]: 1.44 [1.09, 1.89], P=0.009) and moderate-to-severe delirium (odds ratio [95% CI]: 1.44 [1.04, 2.00], P=0.030). Anaesthetic-dose-adjusted frontoparietal alpha power was not associated with pathologic concentrations of CSF pTau-181, Aβ1-42, or pTau-181/Aβ1-42 (P>0.05). In multivariable cognitive models, anaesthetic-dose-adjusted frontoparietal alpha power was associated with preoperative timed processing speed/executive function performance (β [95% CI]: 0.27 [0.06, 0.49], P=0.014), but not with untimed attention/memory performance (β [95% CI]: 0.12 [-0.13, 0.37], P=0.349).
CONCLUSIONS
Lower intraoperative anaesthetic-dose-adjusted frontoparietal alpha power was associated with delirium and delirium-predisposing factors (impaired preoperative processing speed/executive function in timed attention tasks). Larger studies are warranted to confirm these associations after further adjustment for covariates.
背景
我们之前已经表明，术中脑电图α波功率较低与术前认知功能受损（一种谵妄危险因素）相关，并且术中麻醉剂量调整后的脑电图双谱指数值与术后谵妄（POD）风险增加四倍相关。然而，术中麻醉剂量调整后的α波功率与谵妄或谵妄危险因素之间的关联尚未量化。
方法
我们检查了82例年龄≥60岁的非心脏、非神经外科手术患者的脑脊液（CSF）阿尔茨海默病（AD）相关生物标志物、认知评分、脑电图记录和谵妄数据。根据先前的研究，通过将每位参与者术中额顶叶脑电图α波功率除以（2.5减去年龄调整后的呼气末最低肺泡浓度）对其进行麻醉剂量调整，然后分析其与POD、谵妄危险因素、术前CSF AD相关生物标志物和术前认知的关联。
结果
较低的麻醉剂量调整后的额顶叶α波功率与POD几率增加相关（优势比[95%置信区间（CI）]：1.44[1.09，1.89]，P = 0.009）和中度至重度谵妄（优势比[95%CI]：1.44[1.04，2.00]，P = 0.030）。麻醉剂量调整后的额顶叶α波功率与CSF pTau-181、Aβ1-42或pTau-181/Aβ1-42的病理浓度无关（P>0.05）。在多变量认知模型中，麻醉剂量调整后的额顶叶α波功率与术前定时处理速度/执行功能表现相关（β[95%CI]：0.27[0.06，0.49]，P = 0.014），但与非定时注意力/记忆表现无关（β[95%CI]：0.12[-0.13，0.37]，P = 0.349）。
结论
较低的术中麻醉剂量调整后的额顶叶α波功率与谵妄及谵妄易感因素（术前定时注意力任务中处理速度/执行功能受损）相关。需要进行更大规模的研究，在进一步调整协变量后确认这些关联。
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