头颈部癌症大手术后术后谵妄的发病率及危险因素
Incidence and risk factors for postoperative delirium after major head and neck cancer surgery.
作者信息
Booka Eisuke, Kamijo Tomoyuki, Matsumoto Teruaki, Takeuchi Mari, Kitani Takashi, Nagaoka Masato, Imai Atsushi, Iida Yoshiyuki, Shimada Ayako, Takebayashi Katsushi, Niihara Masahiro, Mori Keita, Onitsuka Tetsuro, Tsubosa Yasuhiro, Takeuchi Hiroya, Kitagawa Yuko
机构信息
Division of Head and Neck Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan; Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan; Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Division of Head and Neck Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
出版信息
J Craniomaxillofac Surg. 2016 Jul;44(7):890-4. doi: 10.1016/j.jcms.2016.04.032. Epub 2016 Apr 26.
BACKGROUND
Postoperative delirium is a common and serious complication after extensive surgery. This study aimed to investigate the incidence and risk factors for postoperative delirium after major head and neck cancer surgery.
METHODS
A retrospective analysis was performed for 293 patients who underwent major head and neck cancer surgery lasting >6 h at our institution between January 2012 and November 2015. All data were assessed by two psychiatrists. Univariate and multivariate analyses were performed.
RESULTS
Postoperative delirium developed in 50 (17.1%) patients; most cases (84.0%) of postoperative delirium were observed between postoperative day (POD) 1 and POD 3. Multivariate analysis revealed that an age >70 years was the significant risk factor for postoperative delirium incidence after major head and neck cancer surgery; the multivariate hazard ratio was 3.935 (95% confidence interval 1.873-8.265, p < 0.001).
CONCLUSIONS
Most cases of postoperative delirium after major head and neck cancer surgery were observed between POD 1 and POD 3, and a multivariate analysis revealed that an age >70 years was a significant risk factor for postoperative delirium incidence. Clinicians should pay particular attention to the possibility of delirium incidence during the first 3 days after surgery for patients aged >70 years.
背景
术后谵妄是大型手术后常见且严重的并发症。本研究旨在调查头颈部癌症大手术后术后谵妄的发生率及危险因素。
方法
对2012年1月至2015年11月在我院接受持续时间>6小时的头颈部癌症大手术的293例患者进行回顾性分析。所有数据由两名精神科医生评估。进行单因素和多因素分析。
结果
50例（17.1%）患者发生术后谵妄；大多数术后谵妄病例（84.0%）在术后第1天（POD）至POD 3期间观察到。多因素分析显示，年龄>70岁是头颈部癌症大手术后术后谵妄发生率的显著危险因素；多因素风险比为3.935（95%置信区间1.873 - 8.265，p < 0.001）。
结论
头颈部癌症大手术后大多数术后谵妄病例在POD 1至POD 3期间观察到，多因素分析显示年龄>70岁是术后谵妄发生率的显著危险因素。临床医生应特别关注年龄>70岁患者术后前3天发生谵妄的可能性。
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