术后谵妄神经相关因素的队列研究：连接性和慢波活动的作用
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Cohort study into the neural correlates of postoperative delirium: the role of connectivity and slow-wave activity
背景与目的
谵妄频频影响老年患者，并增加发病率和死亡率，然而，其发病机制尚不清楚。因此我们测试了认知分解模型，并提出慢波活动(SWA)增加引起的额顶叶连接性的破坏会导致谵妄。
方 法
我们召集了70名手术患者进行术前和术后认知功能测试、脑电图、血液生物标记物和术前MRI检查。为了提供因果关系的证据，任何假定的机制都必须在谵妄的诊断上加以区分；根据谵妄的严重程度而成比例改变；并与引起谵妄的已知诱因、炎症相关。在适当的情况下，对分析进行多重校正（MCs）调整。
结 果
回顾分析发现，发生术后谵妄的受试者在手术之前，其弥散张量成像中α功率更高，α波段连接性增加（MC P<0.05），但结构连接性受损（径向扩散率增加；MC P<0.05）。这些连接效应是相互关联的(r2 =0.491; P=0.0012)。手术之后，额叶皮质区局部SWA不足以引起谵妄。相反，谵妄与累及枕顶叶和额叶皮质的SWA增加有关，并伴有功能连接的中断。连接性改变与SWA（r2=0.257; P<0.0001）、谵妄严重程度评级（r2=0.195; P<0.001）、白细胞介素10（r2=0.152; P=0.008）和单核细胞趋化蛋白1（r2=0.253; P<0.001）相关。
结 论
所有术后患者都出现了额叶SWA，但当SWA进展到累及后脑区域时，就会导致谵妄，大多数受试者的连接性也会相应降低。改善SWA和连接性可能为谵妄提供一种新的治疗方法。
原始文献来源及摘要
Tanabe S, Mohanty R, Lindroth H, et al. Cohort study into the neural correlates of postoperative delirium: the role of connectivity and slow-wave activity.[J].Br J Anaesth,2020 Jun 1. pii: S0007-0912(20)30209-9. doi: 10.1016/j.bja.2020.02.027.
Abstract
Background: Delirium frequently affects older patients, increasing morbidity and mortality; however, the pathogenesis is poorly understood. Herein, we tested the cognitive disintegration model, which proposes that a breakdown in frontoparietal connectivity, provoked by increased slow-wave activity (SWA), causes delirium.
Methods: We recruited 70 surgical patients to have preoperative and postoperative cognitive testing, EEG, blood biomarkers, and preoperative MRI. To provide evidence for causality, any putative mechanism had to differentiate on the diagnosis of delirium; change proportionally to delirium severity; and correlate with a known precipitant for delirium, inflammation. Analyses were adjusted for multiple corrections (MCs) where appropriate.
Results: In the preoperative period, subjects who subsequently incurred postoperative delirium had higher alpha power, increased alpha band connectivity (MC P<0.05), but impaired structural connectivity (increased radial diffusivity; MC P<0.05) on diffusion tensor imaging. These connectivity effects were correlated (r2 =0.491; P=0.0012). Postoperatively, local SWA over frontal cortex was insufficient to cause delirium. Rather, delirium was associated with increased SWA involving occipitoparietal and frontal cortex, with an accompanying breakdown in functional connectivity. Changes in connectivity correlated with SWA (r2=0.257; P<0.0001), delirium severity rating (r2=0.195; P<0.001), interleukin 10 (r2=0.152; P=0.008), and monocyte chemoattractant protein 1 (r2=0.253; P<0.001).
Conclusions: Whilst frontal SWA occurs in all postoperative patients, delirium results when SWA progresses to involve posterior brain regions, with an associated reduction in connectivity in most subjects. Modifying SWA and connectivity may offer a novel therapeutic approach for delirium.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：曹莹