| Objective:1.To investigate the influencing factors of short-term consciousness improvement in patients with prolonged disorders of consciousness under general anesthesia.2.To investigate whether alpha energy of EEG under general anesthesia can be used as a prognostic indicator for patients with prolonged disorders of consciousness.Methods:Part Ⅰ: Influencing factors of postoperative short-term improvement of consciousness level in patients with prolonged disorders of consciousness under general anesthesia:Case-control study was used to analyze the clinical data of 55 patients with p Do C.Coma Recovery Scale--Revised(CRS-R)was used to assess the consciousness level of all patients before and after surgery(within 48h)and grade them.The patients were divided into two groups: improved consciousness group and unimproved consciousness group.Gender,age,course of disease,etiology,preoperative level of consciousness,American College of Anesthesiologists grade,surgical factors(surgical method,surgical time,amount of blood loss,urine volume,fluid rehydration),analgesic regimen(sufentanil or sufentanil +refentanil),sedative maintenance drugs propofol and sevoflurane were recorded in the two groups.Single factor analysis was used to analyze the correlation between the above indexes and the improvement of short-term consciousness level in postoperative p Do C patients.Multivariate Logistic regression analysis was used to determine the independent influencing factors of postoperative consciousness improvement in patients with p Do C.Part Ⅱ: The value of EEG alpha energy in predicting the prognosis of patients with prolonged disorders of consciousness under general anesthesia:EEG data of 20 patients with p Do C were collected in the state of wakefulness,general anesthesia and recovery after surgery.Five subbands of clinical interest(delta,theta,alpha,beta,and gamma)were selected to analyze the absolute and relative power spectra of the five bands,and the coherence between each brain region was calculated.3 months after the operation,the patients’ conscious states were assessed by video follow-up or outpatient visits and CRS-R scores were recorded.Results:Part Ⅰ: Univariate analysis showed that preoperative consciousness level,etiology and analgesic program were correlated with postoperative consciousness improvement(all P <0.05).There was no correlation between gender,age,course of disease,American College of Anesthesiologists grade,surgical factors and sedative maintenance drugs(all P > 0.05).Multivariate Logistic regression analysis showed that minimally conscious state(OR=0.09,95%CI 0.02-0.40,P < 0.01),brain trauma(OR=0.06,95%CI 0.01-0.36,P < 0.01)and Sufentanil combined with remifentanil(OR=0.07,95%CI 0.01-0.43,P < 0.01)was significantly associated with postoperative consciousness improvement.Part Ⅱ: 1.Changes in EEG relative power spectrum during anesthesia in p Do C patients:The pattern of changes in alpha relative power induced by anesthesia in p Do C patients is inconsistent(especially in the frontal lobe).No alpha oscillation mode(Group N): delta oscillation is dominant and alpha energy is low;Alpha mode(Group A): delta oscillations and strong frontal lobe alpha energy are present.The difference of the whole brain power spectrum between the two EEG modes was statistically significant: the whole brain alpha relative power of group A was higher than that of group N(P < 0.05).2.The two EEG power spectrum patterns and clinical characteristics: there were no statistical differences between the two EEG patterns under anesthesia and gender,age,etiology,course of disease and narcotic drugs used(all P > 0.05),but were related to preoperative consciousness level and CRS-R score(P < 0.05).The prognosis data of patients three months after surgery were analyzed,and the prognosis of group A was significantly better than group N(P < 0.05).3.Comparison of the coherence between the two EEG modes during anesthesia: In group A,the coherence of alpha band in all brain regions increased during anesthesia compared with before anesthesia.However,in group N,the coherence of alpha band only showed a small increase compared with before anesthesia.Conclusion:1.The preoperative level of consciousness was minimally conscious state,the disease cause of brain trauma and analgesic program(sufentanil combined with remifentanil)were independent influencing factors for postoperative short-term improvement of consciousness level in patients with prolonged disorders of consciousness.2.EEG alpha energy can predict the prognosis of p Do C patients under general anesthesia. |
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