516例头颈部恶性肿瘤根治术后谵妄危险因素分析

目的评估头颈部恶性肿瘤根治术后谵妄的危险因素,为临床制定术后谵妄防治的应对措施提供依据。 方法本研究为回顾性队列研究,纳入2018年10月1日至2021年10月1日于徐州中心医院和上海交通大学医学院附属第九人民医院口腔颌面外科接受头颈恶性肿瘤手术的患者共516例,其中男328例、女188例。对相关危险因素和生命体征进行了回顾和收集。依据谵妄评估量表,将患者分为谵妄组（65例,男44例、女21例）和非谵妄组（451例,男284例、女167例）。采用单变量和多变量Logistic回归分析进行统计学处理。 结果在本项研究中,头颈部恶性肿瘤根治术后谵妄发生率为12.2%（65/516）。组间单因素分析结果显示,年龄（Z = 4.62,P<0.001）、吸烟史（χ² = 5.46,P = 0.019）、酗酒史（χ² = 5.74,P = 0.017）、手术时间（Z = 4.50,P<0.001）、气管切开（χ² = 14.26,P<0.001）、输血（χ² = 22.87,P<0.001）、游离皮瓣移植（χ² = 23.65,P<0.001）、重症监护时间（Z = 2.20,P = 0.028）、术后疼痛VAS值（Z = 3.64,P<0.001）、术后睡眠障碍（χ² = 21.19,P<0.001）、术后发热（χ² = 28.95,P<0.001）与术后谵妄相关。多因素Logistic回归分析结果显示,与谵妄相关的危险因素包括年龄（OR = 1.05,95%CI：1.02 ~ 1.08,P<0.001）、输血（OR = 2.64,95%CI：1.38 ~ 5.03,P = 0.003）、气管切开（OR = 4.02,95%CI：1.61 ~ 10.07,P = 0.003）、术后睡眠障碍（OR = 6.64,95%CI：3.43 ~ 12.84,P<0.001）、发热（OR = 3.28,95%CI：1.39 ~ 7.72,P = 0.007）和术后疼痛视觉模拟评分（VAS）值（OR = 1.42,95%CI：1.17 ~ 1.71,P<0.001）。 结论本研究确定了年龄、是否输血、气管切开、术后睡眠障碍、发热及术后疼痛是头颈部恶性肿瘤根治术后患谵妄的独立危险因素,可采取一定措施,同时提高围手术期的疼痛控制可能有助于预防谵妄的发生。

Risk factors associated with postoperative delirium after surgery for head and neck cancer in 516 consecutive cases

ObjectiveTo determine the risk factors associated with delirium in patients undergoing head and neck cancer surgery, and to provide a reference for clinical prevention and control of postoperative delirium (POD) . MethodsThis retrospective cohort study included 516 patients undergoing head and neck cancer surgery from October 1, 2018 to October 1, 2021 in department of oral maxillofacial head and neck oncology, Xuzhou Center Hospital and Shanghai Ninth People′s Hospital, in which 328 were male and 188 were female. The associated risk factors and vital signs were reviewed and collected. According to the postoperative results evaluated with Confusion Assessment Method (CAM) , the patients were divided into delirium (65 cases, 44 males and 21 females) and non-delirium group (451 cases, 284 males and 167 females) . Univariable and multivariable logistic regression were used to identify the risk factors associated with POD. ResultsThe incidence of delirium after head and neck cancer surgery was 12.2% (65/516) . Single factor analysis between groups in age (Z = 4.62, P<0.001) , smoking (χ² = 5.46, P = 0.019) , drinking (χ² = 5.74, P = 0.017) , operation time (Z = 4.50, P<0.001) , tracheotomy (χ² = 14.26, P<0.001) , intraoperative blood transfusion (χ² = 22.87, P<0.001) , free flap (χ² = 23.65, P<0.001) , ICU guardianship time (Z = 2.20, P = 0.028) , and postoperative VAS pain (Z = 3.64, P<0.001) , sleep disorders (χ² = 21.19, P<0.001) , postoperative fever (χ² = 28.95, P<0.001) showed statistical differences (P<0.05) . Logistic multivariable analysis showed the risk factors associated with POD included age (OR = 1.05, 95%CI: 1.02-1.08, P<0.001) , intraoperative blood transfusion (OR = 2.64, 95%CI: 1.38-5.03, P = 0.003) , tracheotomy (OR = 4.02, 95%CI: 1.61-10.07, P = 0.003) , postoperative sleep disorder (OR = 6.64, 95%CI: 3.43-12.84, P<0.001) , fever (OR = 3.28, 95%CI: 1.39-7.72, P = 0.007) , and postoperative pain (OR = 1.42, 95%CI: 1.17-1.71, P<0.001) . ConclusionsAge, intraoperative blood transfusion, tracheotomy, postoperative sleep disorder, fever and postoperative pain were the risk factors for delirium after head and neck surgery. Active preventive measures improving the pain control should be taken to prevent the occurrence of postoperative delirium.