老年术后谵妄患者术前脑网络功能连接的特征研究

Study on the characteristics of preoperative brain network functional connectivity in elderly patients with postoperative delirium

目的通过静息态功能磁共振成像(rs-fMRI)研究术后谵妄(POD)患者术前脑功能的影像学特征性改变。方法2021年4月—10月,选择34例择期于复旦大学附属华东医院行非心脏大手术的老年患者。术前1 d进行基线资料收集和rs-fMRI扫描,术后采用3 min谵妄诊断量表或ICU意识模糊评估法进行POD评估。根据患者有无POD分为POD组和非POD组。通过基于种子点的功能连接分析观察POD患者术前默认网络(DMN)、突显网络(SN)、中央执行网络(CEN)以及边缘系统网络(LN)中核心脑区的全脑功能连接变化。结果12例患者发生POD,POD发生率为35.29%。校正年龄、性别和受教育时间后,POD患者术前DMN、CEN和LN核心脑区的全脑功能连接强度较非POD患者明显降低。结论POD患者术前DMN、CEN和LN全脑功能连接模式可能存在异常改变,主要表现为连接强度广泛降低。

Objective Resting⁃state functional magnetic resonance imaging(rs⁃MRI)was used to investigate the imaging characteristics of brain function in patients with postoperative delirium(POD)before surgery.Methods Selected 34 elderly pa⁃tients for elective non⁃cardiac major surgery in Huadong Hospital affiliated to Fudan University from April to October 2021.Base⁃line data collection and rs⁃MRI were performed on enrolled patients one day before surgery.After surgery,a professional physi⁃cian used the 3⁃Minute Diagnostic Interview for CAM⁃defined Delirium or Confusion Assessment Method for the Intensive Care U⁃nit to assess POD.Divided the patients into POD group and non⁃POD group based on whether they developed POD.The study ob⁃served the preoperative changes in global functional connectivity of the core regions of the default network,salience network,cen⁃tral executive network,and limbic system network in POD patients,using seed⁃based functional connectivity analysis.Results 12 patients developed POD,and the incidence of POD was 35.29%.After adjusting for age,sex,and educational duration,the preoperative global functional connectivity of the core regions of the default network,central executive network,and limbic sys⁃tem network in POD patients was significantly lower than that in non⁃POD patients.Conclusion There were abnormal preopera⁃tive changes in the global functional connectivity patterns in the default network,central executive network,and limbic system network in patients with POD,and the main manifestation was a widespread decrease in connectivity strength.