{"id":16808,"date":"2019-03-24T05:08:21","date_gmt":"2019-03-23T21:08:21","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=16808"},"modified":"2019-06-02T06:36:01","modified_gmt":"2019-06-01T22:36:01","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9aeeg%e6%8c%87%e5%af%bc%e9%ba%bb%e9%86%89%e5%af%b9%e8%80%81%e5%b9%b4%e6%82%a3%e8%80%85%e6%9c%af%e5%90%8e%e8%b0%b5%e5%a6%84%e7%9a%84%e5%bd%b1%e5%93%8d","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=16808","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1aEEG\u6307\u5bfc\u9ebb\u9189\u5bf9\u8001\u5e74\u60a3\u8005\u672f\u540e\u8c35\u5984\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation<\/h3>\n\n\n\n

Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial<\/h1>\n\n\n\n

Troy S.\u00a0Wildes,\u00a0Angela M.\u00a0Mickle,\u00a0Arbi\u00a0Ben Abdallah,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2019;321(5):473-483. doi:10.1001\/jama.2018.22005Key Points<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Importance<\/strong>\u00a0\u80cc\u666f<\/h2>\n\n\n\n

Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.<\/p>\n\n\n\n

\u672f\u4e2dEEG\u6ce2\u5f62\u6291\u5236\u901a\u5e38\u63d0\u793a\u5168\u9ebb\u8fc7\u6df1\uff0c\u4e14\u4e0e\u672f\u540e\u8c35\u5984\u76f8\u5173\u3002<\/p>\n\n\n\n

Objective<\/strong>\u00a0\u76ee\u7684<\/h2>\n\n\n\n

To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.<\/p>\n\n\n\n

\u8bc4\u4f30EEG\u6307\u5bfc\u9ebb\u9189\u80fd\u5426\u51cf\u5c11\u672f\u540e\u8c35\u5984\u53d1\u751f\u7387<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>\u00a0\u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u5bf9\u8c61<\/h2>\n\n\n\n

Randomized clinical trial of 1232 adults aged 60 years and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.<\/p>\n\n\n\n

\u4f4d\u4e8eSt Louis\u7684Barnes-Jewish\u533b\u9662\u8fdb\u884c\u7684\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u7eb3\u5165\u63a5\u53d7\u5168\u9ebb\u5927\u624b\u672f\u76841232\u540d60\u5c81\u4ee5\u4e0a\u60a3\u8005\u30022015\u5e741\u6708\u81f32018\u5e745\u6708\u5165\u9009\u60a3\u8005\uff0c\u968f\u8bbf\u81f32018\u5e747\u6708\u3002<\/p>\n\n\n\n

Interventions<\/strong>\u00a0\u5e72\u9884\u63aa\u65bd<\/h2>\n\n\n\n

Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n\u2009=\u2009614) or usual anesthetic care (n\u2009=\u2009618).<\/p>\n\n\n\n

\u60a3\u8005\u6309\u71671:1\u7684\u6bd4\u4f8b\u968f\u673a\u5206\u7ec4\uff08\u6839\u636e\u5fc3\u810f\u53ca\u975e\u5fc3\u810f\u624b\u672f\uff0c\u4ee5\u53ca\u8fd1\u671f\u6709\u65e0\u6454\u5012\u75c5\u53f2\u8fdb\u884c\u5206\u5c42\uff09\uff0c\u5206\u522b\u63a5\u53d7EEG\u6307\u5bfc\u9ebb\u9189(n = 614)\u53ca\u5e38\u89c4\u9ebb\u9189(n = 618)\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>\u00a0\u4e3b\u8981\u9884\u540e\u6307\u6807<\/h2>\n\n\n\n

The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures included anesthetic concentration, EEG suppression, and hypotension. Adverse events included undesirable intraoperative movement, intraoperative awareness with recall, postoperative nausea and vomiting, medical complications, and death.<\/p>\n\n\n\n

\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a\u672f\u540e1-5\u5929\u8c35\u5984\u53d1\u751f\u7387\u3002\u672f\u4e2d\u76d1\u6d4b\u6307\u6807\u5305\u62ec\u9ebb\u9189\u836f\u7269\u6d53\u5ea6\uff0cEEG\u6291\u5236\u53ca\u4f4e\u8840\u538b\u3002\u4e0d\u826f\u4e8b\u4ef6\u5305\u62ec\u975e\u9884\u671f\u672f\u4e2d\u6d3b\u52a8\uff0c\u672f\u4e2d\u89c9\u9192\u4f34\u8bb0\u5fc6\uff0c\u672f\u540e\u6076\u5fc3\u5455\u5410\uff0c\u5185\u79d1\u5e76\u53d1\u75c7\u53ca\u6b7b\u4ea1\u3002<\/p>\n\n\n\n

Results<\/strong>\u00a0\u7ed3\u679c<\/h2>\n\n\n\n

Of the 1232 randomized patients (median age, 69 years [range, 60 to 95]; 563 women [45.7%]), 1213 (98.5%) were assessed for the primary outcome. Delirium during postoperative days 1 to 5 occurred in 157 of 604 patients (26.0%) in the guided group and 140 of 609 patients (23.0%) in the usual care group (difference, 3.0% [95% CI, \u22122.0% to 8.0%];\u00a0P<\/em>\u2009=\u2009.22). Median end-tidal volatile anesthetic concentration was significantly lower in the guided group than the usual care group (0.69 vs 0.80 minimum alveolar concentration; difference, \u22120.11 [95% CI, \u22120.13 to \u22120.10), and median cumulative time with EEG suppression was significantly less (7 vs 13 minutes; difference, \u22126.0 [95% CI, \u22129.9 to \u22122.1]). There was no significant difference between groups in the median cumulative time with mean arterial pressure below 60 mm Hg (7 vs 7 minutes; difference, 0.0 [95% CI, \u22121.7 to 1.7]). Undesirable movement occurred in 137 patients (22.3%) in the guided and 95 (15.4%) in the usual care group. No patients reported intraoperative awareness. Postoperative nausea and vomiting was reported in 48 patients (7.8%) in the guided and 55 patients (8.9%) in the usual care group. Serious adverse events were reported in 124 patients (20.2%) in the guided and 130 (21.0%) in the usual care group. Within 30 days of surgery, 4 patients (0.65%) in the guided group and 19 (3.07%) in the usual care group died.<\/p>\n\n\n\n

\u603b\u51711232\u540d\u60a3\u8005\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff08\u4e2d\u4f4d\u5e74\u9f8469\u5c81[\u8303\u56f4, 60 to 95]; 563\u540d\u5973\u6027[45.7%]\uff09\uff0c1213\u540d (98.5%) \u60a3\u8005\u4e3b\u8981\u9884\u540e\u6307\u6807\u53ef\u4f9b\u8bc4\u4f30\u3002\u6307\u5bfc\u7ec4604\u540d\u60a3\u8005\u4e2d157\u540d(26.0%)\u4ee5\u53ca\u5e38\u89c4\u6cbb\u7597\u7ec4609\u540d\u60a3\u8005\u4e2d140\u540d(23.0%)\u672f\u540e1-5\u5929\u53d1\u751f\u8c35\u5984\uff08\u5dee\u5f023.0% [95% CI, \u22122.0% to 8.0%];\u00a0P<\/em>\u2009=\u2009.22\uff09\u3002\u6307\u5bfc\u7ec4\u547c\u6c14\u672b\u53ef\u6325\u53d1\u9ebb\u9189\u836f\u7269\u6d53\u5ea6\u4e2d\u4f4d\u6570\u663e\u8457\u4f4e\u4e8e\u5e38\u89c4\u7ec4\uff08\u6700\u4f4e\u80ba\u6ce1\u6709\u6548\u6d53\u5ea60.69 vs 0.80\uff1b\u5dee\u5f02\u22120.11 [95% CI, \u22120.13 to \u22120.10\uff09\uff0cEEG\u6291\u5236\u7d2f\u79ef\u65f6\u95f4\u4e2d\u4f4d\u6570\u8f83\u4f4e\uff087 vs 13\u5206\u949f\uff1b\u5dee\u5f02\u22126.0 [95% CI, \u22129.9 to \u22122.1]\uff09\u3002\u4e24\u7ec4\u95f4\u5e73\u5747\u52a8\u8109\u538b< 60 mmHg\u7684\u7d2f\u79ef\u4e2d\u4f4d\u65f6\u95f4\u65e0\u663e\u8457\u5dee\u5f02\uff087 vs 7\u5206\u949f\uff1b\u5dee\u5f020.0 [95% CI, \u22121.7 to 1.7]\uff09\u3002\u6307\u5bfc\u7ec4137\u540d\u60a3\u8005(22.3%)\u4e0e\u5e38\u89c4\u7ec495\u540d\u60a3\u8005(15.4%)\u51fa\u73b0\u975e\u9884\u671f\u6d3b\u52a8\u3002\u6ca1\u6709\u60a3\u8005\u62a5\u544a\u672f\u4e2d\u89c9\u9192\u3002\u6307\u5bfc\u7ec448\u540d\u60a3\u8005(7.8%)\u53ca\u5e38\u89c4\u7ec455\u540d\u60a3\u8005(8.9%)\u53d1\u751f\u672f\u540e\u6076\u5fc3\u5455\u5410\u3002\u6307\u5bfc\u7ec4124\u540d\u60a3\u8005(20.2%)\u4e0e\u5e38\u89c4\u7ec4130\u540d\u60a3\u8005(21.0%)\u53d1\u751f\u4e25\u91cd\u4e0d\u826f\u4e8b\u4ef6\u3002\u672f\u540e30\u5929\u5185\uff0c\u6307\u5bfc\u7ec44\u540d\u60a3\u8005(0.65%)\u53ca\u5e38\u89c4\u7ec419\u540d\u60a3\u8005(3.07%)\u6b7b\u4ea1\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>\u00a0\u7ed3\u8bba\u4e0e\u610f\u4e49<\/h2>\n\n\n\n

Among older adults undergoing major surgery, EEG-guided anesthetic administration, compared with usual care, did not decrease the incidence of postoperative delirium. This finding does not support the use of EEG-guided anesthetic administration for this indication.<\/p>\n\n\n\n

\u5bf9\u4e8e\u63a5\u53d7\u5927\u624b\u672f\u7684\u8001\u5e74\u60a3\u8005\uff0c\u4e0e\u5e38\u89c4\u6cbb\u7597\u76f8\u6bd4\uff0cEEG\u6307\u5bfc\u9ebb\u9189\u4e0d\u80fd\u51cf\u5c11\u672f\u540e\u8c35\u5984\u53d1\u751f\u7387\u3002\u8fd9\u4e00\u7ed3\u679c\u4e0d\u652f\u6301\u56e0\u8fd9\u4e00\u6307\u8bc1\u4f7f\u7528EEG\u6307\u5bfc\u9ebb\u9189\u3002<\/p>\n\n\n\n

Trial Registration<\/strong>\u00a0\u8bd5\u9a8c\u6ce8\u518c<\/h2>\n\n\n\n

ClinicalTrials.gov Identifier:\u00a0NCT02241655<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation Effect of Electroencephalography […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16808"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16808"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16808\/revisions"}],"predecessor-version":[{"id":16811,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/16808\/revisions\/16811"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16808"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16808"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16808"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}