Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium.
Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium.
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DOI：
10.1213/ane.0000000000000989
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发表时间：
2016-01
影响因子：
5.7
通讯作者：
Avidan MS
中科院分区：
文献类型：
--
作者：
Fritz BA;Kalarickal PL;Maybrier HR;Muench MR;Dearth D;Chen Y;Escallier KE;Ben Abdallah A;Lin N;Avidan MS
术后谵妄是一种常见的并发症，与发病率和死亡率增加、住院时间延长和医疗费用增加相关。术中脑电图（EEG）减慢以前与术后谵妄有关，但术中EEG抑制与术后谵妄之间的关系尚未研究。在这项观察性队列研究中，纳入了727例接受全身麻醉并计划入住重症监护室（ICU）的成人患者。术中EEG抑制的持续时间从额叶EEG通道（FP 1至F7）记录。在术后第1天至第5天，使用ICU的意识模糊评估方法，每天两次评估谵妄。术后30天，使用VR-12调查、Barthel指数和PROMIS应用认知能力简表4a调查测量生活质量、功能独立性和认知能力。在评估的619例患者中，162例（26%）观察到术后谵妄。当比较无EEG抑制的患者与根据EEG抑制持续时间分为四分位数的患者时，抑制程度更高的患者更可能发生谵妄（χ2（4）= 25，p < 0.0001）。在调整潜在混杂因素后，该效应仍然显著（抑制每增加1分钟，log（EEG抑制）的比值比为1.22 [99% CI 1.06至1.40，p = 0.0002]）。EEG抑制可能与功能独立性降低相关（斯皮尔曼偏相关系数为-0.15，p = 0.02），但与生活质量或认知能力的变化无关。EEG抑制的预测因素包括较高的潮气末挥发性麻醉药浓度和较低的术中阿片类药物剂量。EEG抑制是术后谵妄的独立危险因素。未来的研究应调查麻醉滴定是否能减少EEG抑制，从而降低术后谵妄的发生率。这是SATISFY-SOS手术结局登记研究（NCT 02032030）的子研究。
Postoperative delirium is a common complication associated increased morbidity and mortality, longer hospital stays, and higher healthcare expenditures. Intraoperative electroencephalogram (EEG) slowing has previously been associated with postoperative delirium, but the relationship between intraoperative EEG suppression and postoperative delirium has not been investigated. In this observational cohort study, 727 adult patients receiving general anesthesia with planned intensive care unit (ICU) admission were included. Duration of intraoperative EEG suppression was recorded from a frontal EEG channel (FP1 to F7). Delirium was assessed twice daily on postoperative days 1 through 5 using the Confusion Assessment Method for the ICU. Thirty days after surgery, quality of life, functional independence, and cognitive ability were measured using the VR-12 survey, the Barthel Index, and the PROMIS Applied Cognition-Abilities-Short Form 4a survey. Postoperative delirium was observed in 162 (26%) of 619 patients assessed. When comparing patients with no EEG suppression to those divided into quartiles based on duration of EEG suppression, patients with more suppression were more likely to experience delirium (χ2(4) = 25, p < 0.0001). This effect remained significant after adjusting for potential confounders (odds ratio for log(EEG suppression) 1.22 [99% CI 1.06 to 1.40, p = 0.0002] per 1-minute increase in suppression). EEG suppression may have been associated with reduced functional independence (Spearman partial correlation coefficient −0.15, p = 0.02), but not with changes in quality of life or cognitive ability. Predictors of EEG suppression included higher end-tidal volatile anesthetic concentration and lower intraoperative opioid dose. EEG suppression is an independent risk factor for postoperative delirium. Future studies should investigate whether anesthesia titration to minimize EEG suppression decreases the incidence of postoperative delirium. This is a substudy of the SATISFY-SOS surgical outcomes registry (NCT02032030).