术中脑电图爆发抑制与术后谵妄的关联：系统评价和荟萃分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
脑电图爆发抑制可能与术后谵妄相关，但相关研究结果存在分歧。本系统综述及荟萃分析旨在评估成年外科患者术中爆发抑制与术后谵妄的关联。
方法
系统地更新并检索了 PubMed、MEDLINE、Embase、Google Scholar 和 Cochrane 对照试验中心注册库（截至2023年5月）。作者纳入了队列研究、病例对照研究或随机对照研究，报告成人全麻手术中术中爆发抑制与术后谵妄发生率。主要结果是使用随机效应模型计算术中爆发抑制病例与未爆发抑制病例术后谵妄的汇总比值比（OR）。两名独立研究者提取了数据。该方案在国际前瞻性系统综述注册库中前瞻性注册（注册号 CRD42022326479）；结果根据系统综述和荟萃分析的首选报告项目 (PRISMA) 指南报告。
结果
共纳入14项研究（6,435例患者）。术后谵妄的总体发生率为21.1%（6,435例中的1,358例）。爆发抑制组谵妄发生率显著高于非爆发抑制组（合并OR=1.492，95% CI 1.022–2.178；I²=44%）。谵妄组爆发抑制持续时间更长（标准化均数差=0.462，95% CI 0.293–0.632；I²=63%）。谵妄组爆发抑制比率更高（标准化均数差=0.150，95% CI 0.055–0.245；I²=0%）。
荟萃分析提示术中爆发抑制与术后谵妄存在关联；然而，证据质量极低。有限的研究数量和研究间的巨大异质性凸显了需要进一步开展高质量的研究以得出更可靠的结论。
原始文献：Park SK, Han DW, Chang CH, et al. Association between Intraoperative Electroencephalogram Burst Suppression and Postoperative Delirium: A Systematic Review and Meta-analysis. Anesthesiology. 2025 Jan 1;142(1):107-120. doi: 10.1097/ALN.0000000000005255. PMID: 39388595.
Association between Intraoperative Electroencephalogram Burst Suppression and Postoperative Delirium: A Systematic Review and Meta-analysis
ABSTRACT
Background: Electroencephalogram burst suppression can be associated with postoperative delirium; however, the results of relevant studies are discrepant. This systematic review and meta-analysis aimed to assess the association between intraoperative burst suppression and postoperative delirium in adult surgical patients.
Methods: PubMed, MEDLINE, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials were systematically searched and updated in May 2023. The authors included cohort studies, case-control studies, and randomized controlled studies reporting on postoperative delirium incidence with documented intraoperative burst suppression in adults receiving general anesthesia for any surgery. The primary outcome was the pooled odds ratio for postoperative delirium in cases with intraoperative burst suppression compared to those without burst suppression, calculated using a random-effects model. Two independent investigators extracted the data. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (registration No. CRD42022326479); the results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
Results: Fourteen studies (6,435 patients) were included in the analysis. The overall incidence of postoperative delirium was 21.1% (1,358 of 6,435). Patients with intraoperative burst suppression had a higher incidence of postoperative delirium than those without burst suppression (pooled odds ratio, 1.492; 95% CI, 1.022 to 2.178; I2 = 44%; 95% CI, 0 to 75%; τ2 = 0.110). The intraoperative duration of burst suppression was significantly longer in patients who developed postoperative delirium (standardized mean difference, 0.462; 95% CI, 0.293 to 0.632; I2 = 63%; 95% CI, 16 to 84%; τ2 = 0.027). The burst suppression ratio was significantly higher in the delirium group (standardized mean difference, 0.150; 95% CI, 0.055 to 0.245; I2 = 0%; 95% CI, 0 to 85%; τ2 = 0.00).
Conclusions: The meta-analysis suggests an association between intraoperative burst suppression and postoperative delirium; however, the quality of evidence was very low. The limited number of studies and substantial heterogeneity across them emphasize the need for further high-quality studies to establish a more robust conclusion.