Zhu Yun, Wang Gangpu, Liu Shengwen, Zhou Shanghui, Lian Ying, Zhang Chenping, Yang Wenjun
Department of Oro-maxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai.
Department of General Surgery, The Forth Hospital of Jinan City, Jinan.
Jpn J Clin Oncol. 2017 Jun 1;47(6):505-511. doi: 10.1093/jjco/hyx029.
Postoperative delirium is common after extensive surgery. This study aimed to collate and synthesize published literature on risk factors for delirium in patients with head and neck cancer surgery.
Three databases were searched (MEDLINE, Embase, and Cochrane Library) between January 1987 and July 2016. The Newcastle Ottawa Scale (NOS) was adopted to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods.
They provided a total of 1940 patients (286 with delirium and 1654 without), and predominantly included patients undergoing head and neck cancer surgery. The incidence of postoperative delirium ranged from 11.50% to 36.11%. Ten statistically significant risk factors were identified in pooled analysis. Old age, age >70 years, male sex, duration of surgery, history of hypertension, blood transfusions, tracheotomy, American Society of Anesthesiologists physical status grade at least III, flap reconstruction and neck dissection were more likely to sustain delirium after head and neck cancer surgery.
Delirium is common in patients undergoing major head neck cancer surgery. Several risk factors were consistently associated with postoperative delirium. These factors help to highlight patients at risk of developing delirium and are suitable for preventive action.
广泛手术后术后谵妄很常见。本研究旨在整理和综合已发表的关于头颈癌手术患者谵妄危险因素的文献。
检索了1987年1月至2016年7月期间的三个数据库（MEDLINE、Embase和Cochrane图书馆）。采用纽卡斯尔渥太华量表（NOS）评估研究质量。使用Mantel-Haenszel法和逆方差法估计个体危险因素的合并比值比或平均差异。
他们共纳入了1940例患者（286例发生谵妄，1654例未发生），主要包括接受头颈癌手术的患者。术后谵妄的发生率在11.50%至36.11%之间。在汇总分析中确定了10个具有统计学意义的危险因素。老年、年龄>70岁、男性、手术时间、高血压病史、输血、气管切开术、美国麻醉医师协会身体状况分级至少为III级、皮瓣重建和颈部清扫术在头颈癌手术后更易发生谵妄。
谵妄在接受大型头颈癌手术的患者中很常见。几个危险因素与术后谵妄始终相关。这些因素有助于突出有发生谵妄风险的患者，适合采取预防措施。
