By 丹妮&苗&猫

Association Between Lower Preoperative Cognition  With Intraoperative Electroencephalographic Features  Consistent With Deep States of Anesthesia in Older  Patients

An Observational Cohort Study

老年患者术前低认知与术中脑电图特征之间的关系

一项观察性队列研究

BACKGROUND

Patients with low cognitive performance are thought to have a higher risk of  postoperative neurocognitive disorders． Here we analyzed the relationship between preoperative cognition and anesthesia-induced brain dynamics． We hypothesized that patients with low  cognitive performance would be more sensitive to anesthetics and would show differences in  electroencephalogram (EEG) activity consistent with a brain anesthesia overdose．

认知能力较低的患者被认为术后发生神经认知障碍的风险较高。本研究分析了术前认知与麻醉诱导的脑动力学之间的关系。我们假设认知能力较低的患者对麻醉药更敏感,在实际中会表现出与脑麻醉过量相一致的脑电图(EEG)活动。

METHODS

This is a retrospective analysis from a previously reported observational study． Weevaluated cognitive performance using the Montreal cognitive assessment (MoCA) test． All

patients received general anesthesia maintained with sevoflurane or desflurane during elective

major abdominal surgery． We analyzed the EEG using spectral, coherence, and phase-amplitude

modulation analyses．

这是一项来自先前报道的观察性研究的回顾性分析。我们使用蒙特利尔认知评估(MoCA)测试来评估认知表现。所有患者在择期腹部大手术中均接受七氟醚或地氟醚维持全身麻醉。我们使用频谱、相干性、相位、振幅调制分析来分析脑电图。

RESULTS

Patients were separated into a low MoCA group (<26 points, n = 12) and a high  MoCA group (n = 23)． There were no differences in baseline EEG, nor end-tidal age-corrected  minimum alveolar concentration (MACage)． However, under anesthesia, the low MoCA group had  lower α-β power (high MoCA: 2．9 [interquartile range {IQR}: 0．6–5．8 dB] versus low MoCA: −1．2  [IQR: −2．1 to 0．6 dB], difference 4．1 [1．0–5．7])and a lower α peak frequency (high MoCA: 9．0  [IQR: 8．3–9．8 Hz] versus low MoCA: 7．5 [IQR: 6．3–9．0 Hz], difference 1．5 [0–2．3])compared to  the high MoCA group． The low MoCA group also had a lower α band coherence and a stronger  peak-max phase–amplitude coupling (PAC)． Finally, patients in the low MoCA group had longer  emergence times (high MoCA 663 ± 345 seconds versus low MoCA: 960 ± 352 seconds, difference 297 [15–578])． Multiple linear regression shows up that both age and MoCA scores are  independently associated with intraoperative α-β power．

将患者分别分为低MoCA组(<26分,n=12)和高MoCA组(n=23)。两组的基线脑电图和经年龄校正后呼气末最低肺泡浓度(MACage)均无差异。然而在麻醉状态下,低MoCA组具有较低的α-β功率。高MoCA: 2．9 [IQR: 0．6-5．8 dB] vs 低MoCA: −1．2  [IQR: −2．1-0．6 dB], 差异4．1 [1．0-5．7]和更低的峰值频率。(高MoCA: 9．0  [IQR: 8．3-9．8 Hz] vs 低MoCA: 7．5 [IQR: 6．3-9．0 Hz], 差异1．5 [0-2．3]低MoCA组也具有更低的α波段相干性和更强的峰值相位振幅耦合(PAC)。最后,低MoCA组的患者从麻醉给药结束到拔管的时间更长。(高MoCA 663 ± 345s vs 低MoCA: 960 ± 352s, 差异297 [15-578])。多元线性回归结果显示,年龄和MoCA评分均与术中α-β功率独立相关。

CONCLUSIONS

All these EEG features, together with a prolonged emergence time, are consistent with the possibility that older patients with low cognitive performance are receiving a brain  anesthesia overdose compare to cognitive normal patients．

这些脑电图特征,加上麻醉给药结束至拔管时间的延长,都验证了此种可能:术前认知能力低下的老年患者可能正接受过量麻醉,从而表现出与麻醉药物过量一致的脑电图。

Figure & Table

患者基线特征

           低MoCA组(红色实线,平均值;红色虚线,95%CI)与高MoCA组 (蓝色实线,平均值;红色虚线                95%CI)平均功率谱比较

           A静息条件  B麻醉状态下 C．麻醉给药结束到拔管时间

           D-F组:额叶组平均功率谱的95%CI(橙色线:97．5百分位;蓝色 线:2．5百分位)

           Fp1电极采用左右乳突电极的代数平均值进行参考

           在麻醉条件下,与高MoCA组相比,低MoCA组患者具有较高 慢波功 率(0．1-1Hz)和较低的α-β功率                (9-18Hz)

           麻醉下低MoCA组(红色)和高MoCA组(蓝色)组中位数α波段参数的比较。

           A．α平均功率(dB)  B．α频率峰值(Hz) C．α功率峰值(dB)

           D-F:平均功率,频率峰值,功率峰值与MoCA得分之间的相关性

低MoCA(红色实线、平均值,红色虚线、95%CI)和高MoCA 组(红线虚线、95%CI)

的平均相干性(Fp1-T7电极)比较。

           A．静息条件 B．麻醉下 C．麻醉给药结束到拔管时间

           D-F:组均值一致性的95%CI(橙色线,97．5百分位;蓝色线,2．5百分位)

           在麻醉条件下,低MoCA组患者的α波段(9-12Hz)相干性低于

           高MoCA组

    状态模型方法采用PAC分析

          A．麻醉下低MoCA患者的组平均动态图,对应术中脑电图数据为120s

          B．麻醉下高MoCA患者的组平均动态图,对应术中脑电图数据为120s

          C．低MoCA组(红色实线,平均值;红色 线 95%CI)与高MoCA组(蓝色实线,平均值;红色               虚线,95%CIPAC比较

          D．组平均PAC的95%CI(黑线,97．5百分位;灰线,2．5百分位)

          各组间麻醉剂量及麻醉给药结束到拔管的时间

          A．低MoCA组(红色)和高MoCA 组(蓝色)在整个术中(每15min)的MACage的比较。

          数值用平均值和标准差表示。双向方差分析发现,在不同时间内和两组之间没有差异。

          B．低MoCA 组(红色)与高MoCA组(蓝色)麻醉给药结束到拔管的比较,以秒为单位。

something about 脑电图EGG

概念:一种无创脑部活动测量技术,通过在头皮处安放电极,描记脑神经细胞活动所产生的生物电活动,能够一定程度反映脑的功能状态