Contribution of intraoperative electroencephalogram suppression to frailty-associated postoperative delirium: mediation analysis of a prospective surgical cohort
Contribution of intraoperative electroencephalogram suppression to frailty-associated postoperative delirium: mediation analysis of a prospective surgical cohort
复制标题
术中脑电图抑制对衰弱相关术后谵妄的贡献：前瞻性手术队列的中介分析
DOI：
10.1016/j.bja.2022.11.002
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发表时间：
2022
影响因子：
9.8
通讯作者：
Mervyn Maze
中科院分区：
文献类型：
--
作者：
Panpan Fang;Zixiang Shang;Jian Xu;Jun Hu;Sichen Zhang;Yinguang Fan;Yao Lu;Xuesheng Liu;Mervyn Maze
背景虚弱是术后谵妄（POD）的危险因素，术前干预可以降低但不能消除这种风险。我们假设，EEG抑制，另一个危险因素POD，介导的一些脆弱的风险POD.MethodsA前瞻性队列研究招募患者年龄在65岁或以上，计划在全静脉麻醉下进行非心脏手术。使用FRAIL量表评估虚弱。测量EEG抑制的累积持续时间，定义为麻醉期间大于0.5 s的幅度在-5至5 μV之间。POD通过混淆评估方法（CAM）、CAM-ICU或病历诊断。使用谵妄评定量表-修订版-98（DRS）评估POD的严重程度。中介分析被用来估计之间的关系脆弱，脑电图抑制，和严重程度的POD.ResultsAmong 252例入组患者，51是强大的，129是虚弱前，72是虚弱。被归类为虚弱的患者的EEG抑制持续时间高于强壮组（19 vs0.57 s，P<0.001）或虚弱前组（19 vs3.22 s，P<0.001）。虚弱组的谵妄高峰评分高于强壮组（17 vs 15，P<0.001）和虚弱前组（17 vs 16，P=0.007）。EEG抑制时间介导的24.2%的脆弱-DRS分数association.ConclusionEEG抑制时间介导的脆弱-POD协会在老年非心脏手术患者的统计学显着的一部分。旨在减少EEG抑制时间的试验可能导致术中干预，以减少虚弱患者的POD。临床试验注册ChiCTR 2000041092（中国临床试验注册中心）。
BackgroundFrailty is a risk factor for postoperative delirium (POD), and has led to preoperative interventions that have reduced, but not eliminated, the risk. We hypothesised that EEG suppression, another risk factor for POD, mediates some of the frailty risk for POD.MethodsA prospective cohort study enrolled patients aged 65 yr or older, scheduled for noncardiac surgery under total intravenous anaesthesia. Frailty was assessed using the FRAIL scale. Cumulative duration of EEG suppression, defined as an amplitude between –5 and 5 μV for >0.5 s during anaesthesia, was measured. POD was diagnosed by either confusion assessment method (CAM), CAM-ICU, or medical records. The severity of POD was assessed using the Delirium Rating Scale – Revised-98 (DRS). Mediation analysis was used to estimate the relationships between frailty, EEG suppression, and severity of POD.ResultsAmong 252 enrolled patients, 51 were robust, 129 were prefrail, and 72 were frail. Patients classified as frail had higher duration of EEG suppression than either the robust (19vs0.57 s,P<0.001) or prefrail groups (19vs3.22 s,P<0.001). Peak delirium score was higher in the frail group than either the robust (17vs15,P<0.001) or prefrail groups (17vs16,P=0.007). EEG suppression time mediated 24.2% of the frailty–DRS scores association.ConclusionEEG suppression time mediated a statistically significant portion of the frailty–POD association in older noncardiac surgery patients. Trials directed at reducing EEG suppression time could result in intraoperative interventions to reduce POD in frail patients.Clinical trial registrationChiCTR2000041092 (Chinese Clinical Trial Registry).