髋或膝关节置换术患者术后苏醒期谵妄的前额脑电特征

Prefrontal electroencephalographic characteristics in patients with emergence delirium period after hip or knee arthroplasty

中文关键词: 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: Knee arthroplasty  Hip arthroplasty  Emergence delirium  Electroencephalogram

中文摘要:

      
目的：分析髋或膝关节置换术后发生苏醒期谵妄（ED）患者的前额脑电特征。
方法：选择择期行髋或膝关节置换术的患者64例，男12例，女52例，年龄≥60岁，BMI 18.5～30.0 kg/m²，ASA Ⅱ或Ⅲ级。术后麻醉苏醒期间,采用重症监护室意识模糊评估方法（CAM-ICU）和Richmond躁动-镇静评分(RASS)量表判断ED发生。根据苏醒期是否发生谵妄将患者分为两组：苏醒期谵妄组（ED组）和苏醒期非谵妄组（非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（停药后5～10 min）和完全苏醒后（拔喉罩后15～20 min）两个时间段的数据进行频谱分析。
结果：有28例（44%）患者发生ED。两组苏醒前与完全苏醒时脑电变化一致：频谱边缘频率（SEF）上升，β、γ波功率升高，α波峰值频率降低。与苏醒前比较，非ED组完全苏醒时θ波、α波功率明显降低（P<0.05），α波峰值功率明显降低（P<0.05），ED组完全清醒时α波功率和α波峰值功率差异无统计学意义。与非ED组比较，ED组苏醒前和完全苏醒时样本熵与排列熵均明显升高（P<0.05）。
结论：非ED患者在麻醉苏醒期间θ波、α波功率及α波峰值功率均明显降低，而ED患者在麻醉苏醒期间α波功率及α波峰值功率均无明显变化，同时伴有样本熵与排列熵的升高。

英文摘要:

      
Objective: To analyze the prefrontal electroencephalogram characteristics of patients with emergence delirium (ED) after hip or knee arthroplasty.
Methods: Sixty-four patients undergoing elective hip or knee arthroplasty were selected, 12 males and 52 females, aged ≥ 60 years, BMI 18.5-30.0 kg/m², ASA physical status Ⅱ or Ⅲ. The confusion assessment method-intensive care unit (CAM-ICU) and the Richmond agitation-sedation scale (RASS) were used to determine the occurrence of ED during postoperative anesthesia. The 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 (5-10 minutes after discontinuation of the drug) and after emergence (15-20 minutes after removal of the laryngeal mask) were intercepted and spectrally analyzed.
Results: Twenty-eight patients (44%) developed ED. EEG changes during emergence from anesthesia were consistent in both groups: the spectral edge frequency (SEF) was increased, the β and γ wave power was increased, and the peak α wave frequency was decreased. Compared with the pre-emergence state, the θ and α wave power were significantly lower and the peak α wave power was significantly lower in the non-ED group during full awakening (P < 0.05), and the difference between the α wave power and the peak α wave power was not statistically significant in the ED group during full awakening. Sample entropy and alignment entropy of patients in the ED group before emergence and in full awakening were significantly higher than those in the non-ED group (P < 0.05).
Conclusion: The θ wave power, α wave power, and peak α wave power were significantly lower during emergence from anaesthesia in patients with no delirium. In patients who developed ED, there was no significant change in α wave power or peak α wave power during emergence from anesthesia, but there was an increase in sample entropy and alignment entropy.