516例头颈部恶性肿瘤根治术后谵妄危险因素分析  

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

作　　者：赵姗 杨迎慧 沈梦圆 李晓东 叶为民[3] 李胜男 孟箭[2] Zhao Shan;Yang Yinghui;Shen Mengyuan;Li Xiaodong;Ye Weimin;Li Shengnan;Meng Jian(School of Stomatology,Bengbu Medical College,Bengbu 233000,China;Department of Stomatology,Xuzhou Central Hospital,Xuzhou 221000,China;Department of Oromaxillofacial Head and Neck Oncology,Shanghai Ninth People′s Hospital,College of Stomatology,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;School of Stomatology,Weifang Medical College,Weifang 261000,China)

机构地区：[1]蚌埠医学院口腔医学院,蚌埠233000 [2]徐州市中心医院口腔科,徐州221000 [3]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 [4]潍坊医学院口腔医学院,潍坊261000

出　　处：《中华口腔医学研究杂志（电子版）》2022年第1期34-40,共7页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：江苏省卫生计生委科研资助项目(H2017080);徐州市科技项目(KC21187);徐州医科大学附属医院发展基金(XYFY2020035)。

摘　　要：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。Objective To 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).Methods This 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.Results The 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).Conclusions Age,intraoperative blood transfusion,tracheotomy,postoperative sleep disorder,fever and postoperative pain were the risk factors for delirium after head and neck surgery.Active

关 键 词：头颈部肿瘤 危险因素 术后谵妄 

分 类 号：R78[医药卫生—口腔医学]