暂时性神经功能障碍(TND),A型主动脉夹层(TAAD)手术修复后的常见并发症,与死亡率增加和长期认知障碍密切相关。目前,TND的有效治疗方案仍然难以捉摸。因此,我们试图研究术后相对波段功率(RBP)在预测术后TND发生中的潜力,目的是在TND发作之前识别高危患者。我们在2022年2月至12月间进行了一项前瞻性观察性研究,涉及165名在我们机构接受TAAD手术修复的患者。床边定量脑电图(QEEG)用于监测每个参与者的术后脑电活动,记录RBP的变化(RBPDelta,RBPTheta,RBPBeta和RBPAlpha),并分析其与TND的相关性。采用单变量和多变量分析来确定TND的独立危险因素。随后,生成线图以估计TND的发生率.感兴趣的主要结果是TND的发展,次要结局包括重症监护病房(ICU)入院和住院时间.共有165名患者被纳入研究,其中68人(41.2%)经历过TND。进一步探讨术后TND的独立危险因素,我们对所有变量进行了单变量和多变量逻辑回归分析.在单变量回归分析中,我们确定了年龄(赔率比[OR],1.025;95%CI,1.002-1.049),年龄≥60岁(或,2.588;95%CI,1.250-5.475),心包积血(OR,2.767;95%CI,1.150-7.009),体外循环(CPB)(OR,1.007;95%CI,1.001-1.014),RBP增量(或,1.047;95%CI,1.020-1.077),RBPAlpha(或,0.853;95%CI,0.794-0.907),和Beta(或,0.755;95%CI,0.649-0.855)为术后TND的独立危险因素。进一步的多元回归分析,我们发现CPB时间≥180分钟(OR,1.021;95%CI,1.011-1.032),RBP增量(或,1.168;95%CI,1.105-1.245),和RBPTheta(或,1.227;95%CI,1.135-1.342)为独立危险因素。TND患者的ICU住院时间明显更长(p<0.001),和住院时间(p=0.002)。我们得到了最简单的TND预测模型,由三个变量组成(CPB时间≥180分钟,RBPDelta,RBPTheta,我们在此基础上构建了柱状图。接收器工作特性下的面积(AUROC)为0.821(0.755,0.887)。我们的研究表明,术后RBP监测可以检测TAAD患者围手术期的脑功能变化,为临床医生提供了一种有效的预测方法,可以帮助改善TAAD患者的术后TND。这些发现对改善该人群的临床护理具有重要意义。试用注册ChiCTR2200055980。1月30日注册2022年。该试验在第一个参与者登记之前注册。
Temporary neurological dysfunction (TND), a common complication following surgical repair of Type A Aortic Dissection (TAAD), is closely associated with increased mortality and long-term cognitive impairment. Currently, effective treatment options for TND remain elusive. Therefore, we sought to investigate the potential of postoperative relative band power (RBP) in predicting the occurrence of postoperative TND, with the aim of identifying high-risk patients prior to the onset of TND. We conducted a prospective observational study between February and December 2022, involving 165 patients who underwent surgical repair for TAAD at our institution. Bedside Quantitative electroencephalography (QEEG) was utilized to monitor the post-operative brain electrical activity of each participant, recording changes in RBP (RBP Delta, RBP Theta, RBP Beta and RBP Alpha), and analyzing their correlation with TND. Univariate and multivariate analyses were employed to identify independent risk factors for TND. Subsequently, line graphs were generated to estimate the incidence of TND. The primary outcome of interest was the development of TND, while secondary outcomes included intensive care unit (ICU) admission and length of hospital stay. A total of 165 patients were included in the study, among whom 68 (41.2%) experienced TND. To further investigate the independent risk factors for postoperative TND, we conducted both univariate and multivariate logistic regression analyses on all variables. In the univariate regression analysis, we identified age (Odds Ratio [OR], 1.025; 95% CI, 1.002-1.049), age ≥ 60 years (OR, 2.588; 95% CI, 1.250-5.475), hemopericardium (OR, 2.767; 95% CI, 1.150-7.009), cardiopulmonary bypass (CPB) (OR, 1.007; 95% CI, 1.001-1.014), RBP Delta (OR, 1.047; 95% CI, 1.020-1.077), RBP Alpha (OR, 0.853; 95% CI, 0.794-0.907), and Beta (OR, 0.755; 95% CI, 0.649-0.855) as independent risk factors for postoperative TND. Further multivariate regression analyses, we discovered that CPB time ≥ 180 min (OR, 1.021; 95% CI, 1.011-1.032), RBP Delta (OR, 1.168; 95% CI, 1.105-1.245), and RBP Theta (OR, 1.227; 95% CI, 1.135-1.342) emerged as independent risk factors. TND patients had significantly longer ICU stays (p < 0.001), and hospital stays (p = 0.002). We obtained the simplest predictive model for TND, consisting of three variables (CPB time ≥ 180 min, RBP Delta, RBP Theta, upon which we constructed column charts. The areas under the receiver operating characteristic (AUROC) were 0.821 (0.755, 0.887). Our study demonstrates that postoperative RBP monitoring can detect changes in brain function in patients with TAAD during the perioperative period, providing clinicians with an effective predictive method that can help improve postoperative TND in TAAD patients. These findings have important implications for improving clinical care in this population.Trial registration ChiCTR2200055980. Registered 30th Jan. 2022. This trial was registered before the first participant was enrolled.