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| 术前衰弱老年患者腹腔镜胃肠肿瘤手术中脑电特征与术后谵妄的相关性 |
| Correlation between intraoperative electroencephalographic signatures and postoperative delirium in preoperative frail elderly patients undergoing laparoscopic gastrointestinal tumor surgery |
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| DOI：10.12089/jca.2025.11.009 |
| 中文关键词: 老年 衰弱 脑电图 认知功能 术后谵妄 |
| 英文关键词: Aged Frailty Electroencephalogram Cognitive dysfunction Postoperative delirium |
| 基金项目:秦皇岛市科技计划项目（202501A114） |
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| 摘要点击次数: 1203 |
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| 中文摘要: |
目的：分析术前衰弱老年患者行腹腔镜胃肠肿瘤手术时脑电特征与术后谵妄（POD）的相关性。
方法：选择2023年10月至2024年7月择期行全身麻醉下腹腔镜胃肠肿瘤手术的衰弱老年患者66例，男31例，女35例，年龄65～90岁，BMI 18.5～32.0 kg/m2，ASA Ⅱ或Ⅲ级。使用SedLine监测仪监测患者术前、术中及术后脑电图（EEG）、术中爆发抑制（BS）、患者状态指数（PSI）等。术前1 d采用简易精神状态检查表（MMSE）和Fried表型衰弱量表分别评估术前认知功能以及衰弱情况，术后1、2、3、7 d采用ICU患者意识模糊评估量表（CAM-ICU）评估POD发生情况。根据术后7 d内是否发生POD将患者分为两组：谵妄组（P组）与非谵妄组（N组）。采用多因素Logistic回归分析脑电特征与POD关系，并绘制受试者工作特征（ROC）曲线计算预测POD发生的截断值、敏感性和特异性。
结果：术后7 d内共20例（30.3%）患者发生POD。与N组比较，P组术前、术中、术后α波段功率均明显降低（P＜0.05），BS时间明显延长（P＜0.05），BS发生次数明显增多（P＜0.05）。术中α波段功率降低与POD的发生有关（OR=1.365，95%CI 1.010～1.845，P=0.043）。术中α波段功率预测POD发生的曲线下面积（AUC）为0.762（95%CI 0.645～0.879），取截断值为2.39时，敏感性和特异性分别为0.652和0.800。
结论：术前衰弱老年患者腹腔镜胃肠肿瘤手术中α波段功率可以预测POD的发生，对临床有指导意义。 |
| 英文摘要: |
Objective: To analyze the correlation between electroencephalographic signatures and postoperative delirium (POD) in elderly patients with preoperative frailty undergoing laparoscopic gastrointestinal tumor surgery.
Methods: Sixty-six elderly patients with preoperative frailty, 31 males and 35 females, aged 65-90 years, BMI 18.5-32.0 kg/m2, ASA physical status Ⅱ or Ⅲ, underwent elective laparoscopic gastrointestinal tumor surgery under general anesthesia from October 2023 to July 2024. The SedLine monitor was used to monitor the patients preoperative, intraoperative, and postoperative electroencephalogram (EEG), burst inhibition (BS), patient status index (PSI), etc. The mini-mental state examination (MMSE) and Fried phenotypic frailty scale were used to evaluate the preoperative cognitive function and frailty on the preoperative first day, and the confusion assessment scale for ICU patients (CAM-ICU) was used to evaluate the occurrence of POD on postoperative day 1 , 2, 3, and 7. The patients were divided into two groups according to whether POD occurred within 7 days postoperatively: delirium group (group P) and non-delirium group (group N). Multivariate logistic regression was used to analyze the relationship between EEG features and POD, and the receiver operating characteristic (ROC) curve was plotted to calculate the cut-off value, sensitivity and specificity of predicting the occurrence of POD.
Results: Twenty patients (30.3%) developed POD within postoperative 7 days. Compared with group N, the α power in group P was significantly reduced preoperatively, intraoperatively, and postoperatively (P < 0.05), the BS time was significantly prolonged (P < 0.05), and the number of BS occurrences was significantly increased (P < 0.05). Intraoperative reduction in α power is associated with the occurrence of POD (OR=1.365, 95%CI 1.010-1.845, P=0.043). The area under the curve (AUC) of intraoperative α power for predicting POD was 0.762 (95% CI 0.645-0.879), and the sensitivity and specificity were 0.652 and 0.800, respectively.
Conclusion: The α power in laparoscopic gastrointestinal tumor surgery in elderly patients with preoperative frailty can predict the occurrence of POD, which has guiding significance for clinical practice. |
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