摘要
目的 评价术中脑电监测指导麻醉对老年患者术后认知功能的影响。方法 检索PubMed、Embase、Cochrane Library及Web of Science数据库中关于麻醉深度监测和老年患者术后认知功能的随机对照临床研究。主要指标为术后认知功能障碍和术后谵妄。按照纳入和排除标准进行文献筛选、数据提取和质量评价,用RevMan 5.3软件进行Meta分析。结果 共纳入11篇研究,6 232例受试者。与无指导下麻醉相比,脑电(electroencephalogram,EEG)指导下麻醉者术后谵妄发生率明显较低(OR=0.69,95%CI:0.47~0.99,P<0.05,I2=73%)。与浅麻醉相比,深麻醉者术后谵妄发生率明显较高(OR=1.68,95%CI:1.23~2.29,P<0.05,I2=21%)。与无指导下麻醉相比,EEG指导下全身麻醉者长期术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率较低(OR=0.69,95%CI:0.49~0.97,P<0.05,I2=0%),但短期POCD发生率无差异。与浅麻醉相比,深麻醉者术后短期和长期POCD发生率均较高(OR=2.04,95%CI:1.14~3.64,P<0.05,I2=0%;OR=2.25,95%CI:1.32~3.84,P<0.05,I2=0%)。是否EEG指导和麻醉深浅均未表现出术后死亡率的差异。结论 基于EEG的麻醉监测有助于优化麻醉深度管理,减少老年患者术后谵妄和认知功能障碍的发生。
Objective To assess the effect of electroencephalogram(EEG) monitoring on postoperative cognitive function in elderly patients by an updated meta-analysis.Methods Pub Med,Embase,Cochrane Library databases and Clinical Trials registration database were searched and randomized clinical trials(RCTs) comparing EEG-based and routine care-guided titration of anesthesia were included.The primary outcome was postoperative delirium and postoperative cognitive dysfunction(POCD).The risk estimate from each RCT was pooled in a Meta-analysis using Rev Man 5.3 software.Results We identified 11 RCTs with a total sample size of 6 232.EEG guided anesthesia may decrease the incidence of postoperative delirium(OR=0.69,95%CI:0.47~0.99,P<0.05,I2=73%),and deeper anesthesia was with more postoperative delirium(OR=1.68,95%CI:1.23~2.29,P<0.05,I2=21%).The incidences of late POCD not early POCD were lower in patients receiving EEG guided anesthesia(OR=0.69,95%CI:0.49~0.97,P<0.05,I2=0%).And patients with deeper anesthesia were with more early and late POCD(OR=2.04,95%CI:1.14~3.64,P<0.05,I2=0%;OR=2.25,95%CI:1.32~3.84,P<0.05,I2=0%).There was no significant effect of EEG guided anesthesia or depth of anesthesia on the mortality after surgery.Conclusion EEG-guided anesthesia helps to titrating the anesthesia depth and may reduce the risk of postoperative delirium and POCD in elderly patients.
作者
王佳伟
路志红
WANG Jiawei;LU Zhihong(Department of Anesthesiology and Perioperative Medicine,First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)
出处
《延安大学学报（医学科学版）》
2024年第2期65-70,106,共7页
Journal of Yan'an University:Medical Science Edition
基金
国家自然科学基金(82293644,82371476)。
关键词
脑电
监测
老年患者
术后认知功能
META分析
Electroencephalogram
Monitoring
Elderly patients
Postoperative cognitive function
Meta-analysis
