文章摘要
术中alpha功率在认知储备与老年患者非心脏手术后谵妄间的中介作用
Mediating role of intraoperative alpha power in the association between cognitive reserve and postoperative delirium in elderly patients undergoing non-cardiac surgery
  
DOI：10.12089/jca.2025.09.003
中文关键词: 术后谵妄  认知储备  脑电图  alpha功率  老年
英文关键词: Postoperative delirium  Cognitive reserve  Electroencephalography  Alpha power  Aged
基金项目:国家自然科学基金面上项目（82372182）
作者单位E-mail
张绍刚 210014,南京中医药大学附属南京市中西医结合医院麻醉科  
周田田 210014,南京中医药大学附属南京市中西医结合医院麻醉科  
陈一林 210014,南京中医药大学附属南京市中西医结合医院麻醉科  
童建华 南京医科大学第二附属医院麻醉科  
安静 南京医科大学第二附属医院麻醉科 anjing031020@126.com 
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中文摘要:
      
目的：探讨术中alpha功率在认知储备与老年患者非心脏手术后谵妄（POD）之间关系的中介作用。
方法：收集接受全身麻醉的非心脏手术患者234例，男126例，女108例，年龄65～80岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ或Ⅲ级。评估术前认知储备，记录术中额叶EEG数据，并采用多锥度方法估计功率谱。主要结局为术后3 d内POD的发生率。采用多元Logistic回归和中介分析探讨POD的独立危险因素及alpha功率的中介作用。
结果：有64例（27.4%）患者术后3 d内发生POD。低认知储备 （OR=2.59， 95%CI 1.41～4.77， P=0.003）、术中低alpha功率（OR=1.74， 95%CI 1.53～2.21， P<0.001）、高ASA 分级（OR=13.26， 95%CI 2.37～74.04， P=0.003）、低简易精神状态检查量表（MMSE）评分（OR=1.10， 95%CI 1.06～1.21， P<0.001）及高年龄调整的Charlson合并症指数（ACCI） （OR=1.60， 95%CI 1.07～2.39， P=0.021）是POD的独立危险因素。调整年龄、ASA、教育水平、抑郁史、ACCI、衰弱、MMSE、血红蛋白、血小板与淋巴细胞比率、theta功率及beta功率协变量后，低认知储备对POD的总效应为14.3 （95%CI 3.8～24.6， P=0.013），直接效应为12.1 （95%CI 1.1～23.4， P=0.018），通过alpha功率的间接效应为2.3（95%CI 0.3～4.8， P=0.026），占总效应的16.1% （95%CI 7.6%～30.1%， P=0.025）。
结论：低认知储备与术中低alpha功率异常均为POD的独立危险因素，术中alpha功率在POD发生机制中具有重要中介作用。
英文摘要:
      
Objective: To explore the mediating role of intraoperative alpha power in the association between cognitive reserve and postoperative delirium (POD) in elderly patients undergoing non-cardiac surgery.
Methods: A total of 234 patients undergoing non-cardiac surgery under general anesthesia were included, 126 males and 108 females, aged 65-80 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅱ or Ⅲ. Preoperative cognitive reserve was assessed, intraoperative frontal EEG data were recorded, and the power spectrum was estimated using a multitaper method. The primary outcome was the incidence of POD, defined as any occurrence within 3 days postoperatively. Multivariate Logistic regression and mediation analyses were used to identify independent risk factors for POD and to examine the mediating effect of EEG characteristics.
Results: Sixty-four patients (27.4%) experiencing POD within 3 days post-surgery. Lower cognitive reserve (OR = 2.59, 95% CI 1.41-4.77, P = 0.003), low intraoperative alpha power (OR = 1.74, 95% CI 1.53-2.21, P < 0.001), high ASA physical status(OR = 13.26, 95% CI 2.37-74.04, P = 0.003), low mini-mental state examination (MMSE) (OR = 1.10, 95% CI 1.06-1.21, P < 0.001), and high age-adjusted Charlson comorbidity index (ACCI) (OR = 1.60, 95% CI 1.07-2.39, P = 0.021) were identified as independent risk factors for POD. After adjusting for covariates including age, ASA, education level, history of depression, ACCI, frailty, MMSE, hemoglobin, platelet to lymphocyte ratio, theta power, and beta power, the total effect of low cognitive reserve on POD was 14.3 (95% CI 3.8-4.6, P = 0.013), the direct effect was 12.1 (95% CI 1.1-23.4, P = 0.018), and the indirect effect through alpha power was 2.3 (95% CI 0.3-4.8, P = 0.026), accounting for 16.1% of the total effect (95% CI 7.6%-30.1%, P = 0.025).
Conclusion: Both low cognitive reserve and intraoperative alpha power abnormalities are independent risk factors for POD, with intraoperative alpha power playing a significant mediating role in the development of POD.
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