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| 老年关节置换术后苏醒期谵妄患者的前额脑电特征 |
| Prefrontal electroencephalographic characteristics of elderly patients with deliriumduring the emergence period after arthroplasty |
| 投稿时间：2023-12-02 修订日期：2024-04-15 |
| DOI： |
| 中文关键词: 老年患者 膝关节置换术 髋关节置换术 苏醒期谵妄 脑电图 |
| 英文关键词: Elderly patients Knee arthroplasty Hip arthroplasty Emergence Delirium EEG |
| 基金项目:国家自然科学基金项目（面上项目，重点项目，重大项目） |
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| 中文摘要: |
| 目的 观察老年患者髋或膝关节置换术后苏醒期谵妄的前额脑电特征。方法 选择择期行髋或膝关节置换术的老年患者 ，男12例，女52例 ，年龄≥60岁 ， BMI 18~30 kg/m2，ASA 分级Ⅱ~Ⅲ。术后麻醉苏醒期间采用重症监护室意识模糊评估方法(Confusion Assessment Method-Intensive Care Unit, CAM-ICU)和Richmond躁动-镇静评分(RASS)量表 判断苏醒期谵妄发生。根据麻醉苏醒期是否发生谵妄将患者分为两组：苏醒期谵妄组（ED组）和非苏醒期谵妄组（Non-ED组）。收集脑电监测仪中患者苏醒期原始脑电图数据，并截取苏醒前和苏醒后两个时间段 的数据进行频谱分析。结果 本研究中发生苏醒期谵妄的有28例（43.75%）。比较两组患者苏醒前与完全清醒状态脑电功率谱，麻醉苏醒过程脑电变化趋势一致：频谱边缘频率(Spectral Edge Frequency，SEF)上升，β、γ波功率增加，α峰值频率降低。从苏醒前到完全清醒状态，非ED组伴有θ波、α波功率下降显著（P=0.004，P=0.009），α峰值功率下降显著（P=0.009），而ED组α波功率及α峰值功率下降均不显著。ED组患者苏醒前和完全清醒两个时间段的样本熵与排列熵均显著高于Non-ED组（P < 0.001）。结论 老年患者麻醉苏醒期出现的苏醒期谵妄相关特征性脑电图，可以帮助麻醉医师早期识别出ED高风险患者。 |
| 英文摘要: |
| Objective To observe the prefrontal electroencephalogram characteristics of emergence delirium after hip or knee arthroplasty in elderly patients. Methods Elderly patients undergoing elective hip or knee arthroplasty were selected, 12 males and 52 females, aged ≥60 years, with a BMI of 18-30 kg/m2 and an ASA classification of Ⅱ to Ⅲ. The Confusion Assessment Method-Intensive Care Unit (CAM-ICU) and the Richmond Agitation-Sedation Scale (RASS) were used to determine the occurrence of delirium during postoperative anesthesia. Patients were divided into two groups according to whether delirium occurred during emergence from anesthesia: the emergence delirium group (ED group) and the non-emergence delirium group (non-ED group). The patients' raw EEG data during the emergence phase were recorded by the EEG monitor, and the data from before and after emergence were intercepted and spectrally analyzed. Results 28 patients (43.75 %) in this study developed emergence delirium. Comparing the EEG power spectra of the two patient groups before emergence and in the fully awake state, the trend of EEG changes during emergence from anesthesia was the same: the spectral edge frequency (SEF) increased, the β and γ wave power increased, and the α-peak frequency decreased. From emergence before anesthesia to full awakening, there was a significant decrease in theta and alpha wave power (P = 0.004, P = 0.009) and a significant decrease in peak alpha wave power (P = 0.009) in the non-ED group, whereas the ED group had a non-significant decrease in both alpha wave power and peak alpha wave power. The sampling entropy and the alignment entropy of the patients in the ED group were significantly higher than in the non-ED group for both the time before emergence and the time in the fully awake state (P < 0.001).Conclusion The characteristic EEG associated with emergence delirium in elderly patients may help anesthesiologists to identify patients at high risk of ED early. |
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