Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis.
Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis.
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DOI：
10.1097/aln.0000000000002323
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发表时间：
2018-09
期刊：
影响因子：
8.8
通讯作者：
Leung JM
中科院分区：
文献类型：
--
作者：
MacKenzie KK;Britt-Spells AM;Sands LP;Leung JM
在≥ 65岁的患者中，约15%-20%的大手术并发术后谵妄，并与不良结局和资源利用增加相关。此外，术后谵妄患者也可能有发生长期术后认知功能障碍的风险。一个潜在的可修改的变量是使用术中处理的脑电图来指导麻醉。本系统综述和荟萃分析探讨了处理脑电图监测与术后谵妄和认知功能障碍之间的关系。使用奥维德MEDLINE、PubMed、EMBASE、科克伦图书馆和Google检索，使用关键词：处理后脑电图、脑电双频指数、术后谵妄、术后认知功能障碍，对随机对照试验进行系统检索。筛选和数据提取由两名独立的评审员进行，并评估偏倚风险。采用固定效应模型计算的术后谵妄联合效应估计值表示为比值比（OR）和95%置信区间（95%CI）。369个检索结果中有13个符合纳入标准。由于结果测量的异质性，术后认知功能障碍数据被排除在荟萃分析之外;对结果进行了后续讨论。5项研究被纳入定量术后谵妄分析，数据汇总自2，654例患者。三项研究的偏倚风险较低，另外两项研究的偏倚风险尚不清楚。使用经处理的脑电图引导的麻醉与术后谵妄发生几率降低38%相关（OR = 0.62; p<0.001; 95%CI，0.51 - 0.76）。处理脑电图引导麻醉与术后谵妄减少有关。然而，解释这种关联的机制尚未确定。数据不足以评估处理脑电图监测与术后认知功能障碍之间的关系。
Postoperative delirium complicates approximately 15%–20% of major operations in patients ≥ 65 years and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction. A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords: processed electroencephalogram, bispectral index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios (OR) with 95% confidence intervals (95%CI). Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis due to heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (OR = 0.62; p<0.001; 95%CI, 0.51 to 0.76). Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association however, is yet to be determined. Data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.