Anaesthetic depth and delirium after major surgery: a randomised clinical trial
Anaesthetic depth and delirium after major surgery: a randomised clinical trial
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麻醉深度与大手术后谵妄：一项随机临床试验
DOI：
10.1016/j.bja.2021.07.021
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发表时间：
2021-11-01
影响因子：
9.8
通讯作者：
Short, Timothy G.
中科院分区：
文献类型：
--
作者：
Evered, Lisbeth A.;Chan, Matthew T., V;Short, Timothy G.
背景资料：术后谵妄是一种严重的手术并发症，与住院时间延长、长期认知能力下降和死亡率相关。本研究旨在确定是否目标脑电双频指数（BIS）读数为50（轻度麻醉）与POD发生率低于目标BIS读数35相关方法：这项多中心随机临床试验纳入了来自3个国家8个中心的655例接受大手术的高危患者，采用3分钟意识模糊评估法（3D-CAM）或CAM-ICU，并在基线和出院时使用简易精神状态检查进行认知筛查，在30天和1年时使用简易精神测试评分（AMTS）。患者被分配到轻度或深度麻醉。主要结局是术后前5天内任何一天出现术后谵妄。次要结局包括术后1年死亡率、出院时认知功能下降、30天和1年时认知功能损害、计划外ICU入院、住院时间和脑电图爆发抑制时间。结果：BIS 50组术后谵妄发生率为19%，BIS 35组为28%（比值比0.58 [95%置信区间：0.38-0.88]; P=0.010）。在1年时，BIS 50组的患者表现出比BIS 35组明显更好的认知功能（AMTS为9
Background: Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia).Methods: This multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary outcomes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression.Results: The incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38-0.88]; P=0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS