术后谵妄患者围术期脑电特征及临床研究进展

Perioperative EEG Characteristics and Clinical Research Progress in Patients with Postoperative Delirium

摘要: 术后谵妄(Postoperative Delirium, POD)是围术期常见的急性脑功能障碍综合征，以意识波动、注意力不集中及认知功能急性改变为核心特征，尤其好发于老年患者、大手术后及重症监护环境。POD不仅显著延长住院时间、增加医疗费用，还与长期认知功能下降及术后死亡率升高密切相关。近年来，脑电图(Electroencephalogram, EEG)凭借无创、高时间分辨率及可实时动态监测大脑功能状态的优势，已成为POD神经电生理标志物研究的重要工具。大量研究证实，围术期EEG特征性改变——包括α振荡功率降低、慢波活动增多、爆发抑制频发及脑区功能连接减弱——与POD的发生、发展轨迹及严重程度存在强关联。本文基于中国知网、PubMed等主流数据库近年刊发的优质文献，系统综述了不同年龄分层、不同手术类型及围术期各阶段(术前、术中、苏醒期、术后)患者EEG特征的异同，重点聚焦于α振荡慢化、慢波活动增多、爆发抑制及功能连接减弱等核心电生理标志物。在此基础上，本文对未来研究方向提出展望，主要包括：建立标准化的EEG分析流程以提升研究可比性；开发便携式无线监测设备便于临床推广应用；融合多组学与人工智能技术构建多模态预测模型；以及开展靶向脑电异常的干预试验等。通过系统整合当前证据，本文旨在为术后谵妄的早期识别、风险分层及精准防治提供理论依据与临床参考，同时客观评述现有研究的争议与不足，并展望精准围术期脑功能保护的未来发展方向。

Abstract: Postoperative delirium (POD) is a common acute brain dysfunction syndrome in the perioperative period, characterized by fluctuations in consciousness, inattention, and acute changes in cognition. It is particularly prevalent in elderly patients, after major surgery, and in intensive care settings. POD not only significantly prolongs hospital stays and increases medical costs but is also strongly associated with long-term cognitive decline and increased postoperative mortality. In recent years, electroencephalography (EEG), owing to its non-invasiveness, high temporal resolution, and ability to provide real-time dynamic monitoring of brain functional status, has become an important tool in the study of neurophysiological biomarkers for POD. A large body of research has confirmed that characteristic perioperative EEG changes—including reduced alpha oscillation power, increased slow-wave activity, frequent burst suppression, and decreased functional connectivity between brain regions—are strongly associated with the occurrence, trajectory, and severity of POD. Based on high-quality literature published in recent years from mainstream databases such as CNKI and PubMed, this article systematically reviews the similarities and differences in EEG characteristics across different age strata, surgical types, and perioperative phases (preoperative, intraoperative, emergence, and postoperative), with a focus on core electrophysiological markers including alpha oscillation slowing, increased slow-wave activity, burst suppression, and decreased functional connectivity. On this basis, this article proposes future research directions, including: establishing standardized EEG analysis procedures to improve study comparability; developing portable wireless monitoring devices to facilitate clinical application; integrating multi-omics and artificial intelligence technologies to construct multimodal predictive models; and conducting intervention trials targeting EEG abnormalities. By systematically synthesizing current evidence, this article aims to provide a theoretical basis and clinical reference for the early identification, risk stratification, and precise prevention and treatment of POD, while objectively discussing the controversies and limitations of existing research and envisioning future directions for precision perioperative brain function protection.