术后认知功能障碍患者的定量脑电图特点  

Characterization of quantitative EEG in patients with postoperative cognitive dysfunction

作　　者：张北源[1] 尤勇[1] 虞文魁 顾勤[1] ZHANG Bei-yuan;YOU Yong;YU Wen-kui;GU Qin(Department of Critical Care Medicine,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院重症医学科

出　　处：《医学研究生学报》2019年第7期724-728,共5页Journal of Medical Postgraduates

基　　金：江苏省社会发展项目(133112)

摘　　要：目的目前定量脑电图用于术后认知功能障碍(POCD)患者的相关研究报道较少。文中旨在探讨POCD患者的定量脑电图特点,为早期发现和诊断POCD提供帮助。方法选择2018年1月至10月南京大学医学院附属鼓楼医院重症医学科收治的术后患者31例。依据手术前后简易智力状态评定量表评分变化(△MMSE)分为2组:POCD组(△MMSE>2分,n=11)、对照组(△MMSE≤2分,n=20)。所有患者均使用脑电图仪进行床旁监测,采用国际通用10~20系统安放电极,双极纵联F3-P3,F4-P4四通道,选取连续10min剪辑计算平均值。对振幅整合脑电图、相对频带能量、相对α变异及频谱熵进行分析,并观察相对频带能量、相对α变异与△MMSE的相关性。结果POCD组术后MMSE总分、定向力、记忆力评分[(18.91±2.34)、(6.82±1.47)、(2.09±1.04)分]显著低于对照组[(28.35±1.27)、(9.75±0.44)、(2.90±0.31)分],差异有统计学意义(P<0.05),注意力和计算力、回忆力及语言评分亦明显降低(P<0.05)。POCD组左、右侧α变异[(14.39±8.25)%、(15.70±9.59)%]、左、右侧α频带能量[(3.83±2.62)μV^2、(3.82±2.51)μV^2]较对照组[(22.59±10.98)%、(24.07±9.73)%及(7.17±4.73)μV^2、(6.94±4.53)μV^2]显著下降(P<0.05)。左侧α变异、右侧α变异、左侧α频带能量、右侧α频带能量与△MMSE评分均存在明显的负相关(r左侧α变异=-0.793,P=0.004;r右侧α变异=-0.835,P=0.00l;r左侧α频带能量=-0.633,P=0.037;r右侧α频带能量=-0.682,P=0.021)。结论POCD患者中量化脑电图多表现为α频带能量、α变异显著下降,可为早期发现和诊断POCD提供帮助。Objective Very few studies have been reported on the application of quantitative electroencephalogram (qEEG) in patients with postoperative cognitive dysfunction (POCD). This study was to investigate the qEEG features of POCD and provide some help for the early detection and diagnosis of the condition. Methods We enrolled 31 postoperative patients treated in our Department of Critical Care Medicine from January 2018 to October 2018. Based on the pre- and post-operative scores on the Mini-Mental State Examination (MMSE), we divided the patients into a POCD (MMSE score >2, n = 11) and a non-POCD control group (MMSE score ≤2, n = 20). Using the brain function instrument, the electrode set according to the standard international 10-20 system and with bipolar longitudinal F3-P3 and F4-P4 four channels, we conducted bedside monitoring for all the patients and calculated the average value of the consecutive clips of 10-min qEEG. Then, we analyzed the amplitude-integrated EEG (aEEG), relative frequency band energy, relative α variability and spectrum entropy, and the correlation of relative frequency band energy and relative α variability with the MMSE scores. Results Compared with the non-POCD controls, the POCD patients showed significant decreases in the total MMSE scores (28.35 ± 1.27 vs 18.91 ± 2.34, P < 0.05), orientation score (9.75 ± 0.44 vs 6.82 ± 1.47, P < 0.05) and memory score (2.90 ± 0.31 vs 2.09 ± 1.04, P < 0.05) as well as in the concentration, calculation, recalling and language scores (all P < 0.05);and the POCD patients also exhibited marked reduction in the left α variability ([22.59 ± 10.98]% vs [14.39 ± 8.25]%, P < 0.05), right α variability ([24.07 ± 9.73]% vs [15.70 ± 9.59]%, P < 0.05), left α frequency band energy ([7.17 ± 4.73] vs [3.83 ± 2.62]μV2, P < 0.05) and right α frequency band energy ([6.94 ± 4.53] vs [3.82 ± 2.51]μV2, P < 0.05). The MMSE scores were found to be negatively correlated with left α variability (r =-0.793, P = 0.004), right α variability (r =-0.835,

关 键 词：术后认知功能障碍 定量脑电图 简易智力状态评定量表 

分 类 号：R65[医药卫生—外科学]