238例头颈肿瘤患者重建术后谵妄危险因素分析  

Risk factors analysis of delirium after head and neck reconstruction in 238 consecutive cases

作　　者：李晓东 孟箭[1,3] 张凌 叶为民[2] LI Xiao-dong;MENG Jian;ZHANG Ling;YE Wei-min(I.School of Stomatology,Weifung Medical University,Weifang 261000,Shandong Prorince;Department of Oromcillofaciad Head and Neck Oncology,Shanghai Ninth People's Haspital,College of Stomatology,Shanghai Jico Tong Unirersity School of Medicine.Shanghai 200011;Department of Stomatology,Xuzhou Central Hospital.Xuzhou 221000,Jiangsu Prorince,China)

机构地区：[1]潍坊医学院口腔医学院,山东潍坊261000 [2]上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,上海200011 [3]徐州市中心医院口腔科,江苏徐州221000

出　　处：《中国口腔颌面外科杂志》2020年第3期226-230,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81771127);徐州医学创新(技术攻关)团队项目(XWCX201604);江苏省卫生健康委科研课题(H2017080);徐州市科技重点研发计划(KC17196)。

摘　　要：目的:探讨头颈肿瘤患者重建术后谵妄发病的相关危险因素。方法:选择2018年10月-2019年10月于上海交通大学医学院附属第九人民医院接受头颈肿瘤术后重建患者238例,其中男160例,女78例;年龄16~85岁,平均(56.52±15.31)岁。依据《谵妄评估量表》结果,将患者分为谵妄组和非谵妄组,采用SPSS 17.0软件包分析患者术后谵妄的发病率和相关危险因素。结果:头颈肿瘤重建术后谵妄发病率为10.1%(24/238)。组间单因素分析发现,高龄、高血压、既往谵妄、术前睡眠紊乱、术后睡眠紊乱、术中输血、术后疼痛差异有统计学意义(P<0.05);多因素Logistic回归分析发现,高龄(OR=1.090)、术后睡眠紊乱(OR=15.248)、术中输血(OR=1.003)、术后疼痛(OR=1.398)是患者术后发生谵妄的独立危险因素。结论:头颈肿瘤重建术后高龄、术中输血、术后睡眠紊乱和术后疼痛是谵妄发病的高危因素,应采取一定的预防措施,减少术后谵妄的发生。PURPOSE:To observe and analyze the risk factors of postoperative delirium in patients undergoing head and neck reconstruction after tumor surgery.METHODS:From October 2018 to October 2019,238 patients with head and neck reconstruction at the Department of Oromaxillofacial Head and Neck Oncology of Shanghai Ninth People's Hospital were included in this study.Among 238 cases,160 were male and 78 were female.The average age was 56.52±15.31 years(rage:16 to 85).According to postoperative results evaluated with Confusion Assessment Method(CAM),they were divided into delirium group and control group.The incidence and related risk factors of delirium were analyzed using SPSS 17.0 software package.RESULTS:The incidence of delirium after head and neck reconstruction was 10.1%(24/238).Single factor analysis results showed that delirium was associated with advanced age,hypertension,history of delirium,preoperative sleep disorder,postoperative sleep disorder,intraoperative blood transfusion and postoperative pain.Multiplelogistic regression analysis indicated that the perioperative risk factors of delirium included advanced age(OR=1.090),postoperative sleep disorder(OR=15.248),intraoperative blood transfusion(OR=1.003),and postoperative pain(OR=1.398).CONCLUSIONS:Patients with advanced age,intraoperative blood transfusion,postoperative sleep disorder and postoperative pain are the high risk groups for delirium after head and neck reconstruction.Active preventive measures should be taken to reduce the occurrence of postoperative delirium.

关 键 词：术后谵妄 头颈肿瘤 缺损重建 危险因素 

分 类 号：R782.05[医药卫生—口腔医学]