老年糖尿病患者术中SedLine脑电监测与术后谵妄的相关性研究

Objective: To explore the correlation between intraoperative SedLine data and postoperative delirium (POD) in elderly patients with diabetes mellitus. Methods: Between October 2019 and January 2020, elderly patients (≥65 years old) with diabetes undergoing elective surgery under general anesthesia were selected in the study, with cardiac function and ASA physical status of Ⅰ-Ⅲ. We excluded patients who underwent neurosurgical, cardiac, or transplantation surgery, were unsuitable for placement of electrodes on the head, or were not cooperative in the evaluation completion. Basic data were collected, including age, sex, body mass index, education, smoking, and cardiopulmonary co-morbidities. In addition to routine intraoperative monitoring, the patients received SedLine multi-channel electroencephalogram (EEG) monitoring and spectrum analysis, including original EEG, patient state index (PSI), burst suppression (BS), electroencephalogram (EMG) and density spectral array (DSA). The intraoperative SedLine data of the patients were observed and recorded. During hospitalization, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Montreal Cognitive Assessment (MoCA) were performed on the day before operation and postoperative day 1, 2, 3 and 7 to diagnose POD and postoperative cognitive dysfunction (POCD), respectively. T-test was used to screen the intraoperative EEG parameters with differences among groups. Associations were analyzed using binary Logistic regression analysis and ROC curve was used to calculate the cut-off score, sensitivity and specificity. Results: There was no significant difference in baseline data between the two groups. The incidence of POCD in patients with POD was 57.2% higher than that in patients without POD (P=0.019). The two groups did not significantly differ in the duration of operation and anesthesia or hospital stay. There was no significant difference in the time of PSI<25 or BS between the two groups. Intraoperative EEG spectrum domain analysis showed that the alpha power in 10-14 Hz of patients with POD was significantly lower than that of non-POD patients (P<0.05). There was a significant correlation between them (P<0.05, OR=1.4, 95% CI: 1.036-1.855). The area under the ROC was 0.8 (95% CI: 0.6-0.9), and the diagnostic sensitivity and specificity were 66.7% and 80.4%, respectively when the diagnostic limit value was 0.5. Conclusion: There is a significant correlation between the low alpha wave power of EEG during operation and the occurrence of POD in elderly patients with diabetes mellitus.