Makiguchi T, Yokoo S, Kurihara J
Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
Int J Oral Maxillofac Surg. 2018 Aug;47(8):998-1002. doi: 10.1016/j.ijom.2018.03.011. Epub 2018 Apr 10.
The aim of this study was to investigate risk factors for postoperative delirium in patients undergoing free flap reconstruction for defects after oral cancer resection. This was a non-randomized, retrospective cohort study involving 102 patients who underwent oral cancer resection and free flap reconstruction. Data were collected from the medical records. Postoperative delirium occurred in 34 patients (33.3%), of whom 27 were male and seven were female. High preoperative total protein and albumin, diabetes mellitus, history of smoking, use of hypnotics or antipsychotics, time until getting out of bed after surgery, and postoperative insomnia were significantly related to delirium in the univariate analysis (P<0.05). In a multiple logistic regression model, high preoperative albumin (odds ratio 4.45), postoperative insomnia (odds ratio 10.72), and history of smoking (odds ratio 2.91) were significant risk factors for delirium (P<0.05). The analysis of laboratory data before and after surgery showed greater decreases in albumin, total protein, and haemoglobin after surgery in patients with postoperative delirium than in those without this condition. These results show that the perioperative maintenance of nutritional status and early postoperative management of the sleep cycle are important to prevent delirium after oral cancer resection and free flap reconstruction.
本研究旨在调查口腔癌切除术后缺损行游离皮瓣重建患者术后谵妄的危险因素。这是一项非随机、回顾性队列研究，纳入了102例行口腔癌切除及游离皮瓣重建的患者。数据从病历中收集。34例患者（33.3%）发生术后谵妄，其中男性27例，女性7例。单因素分析显示，术前总蛋白和白蛋白水平高、糖尿病、吸烟史、使用催眠药或抗精神病药、术后下床时间以及术后失眠与谵妄显著相关（P<0.05）。在多因素逻辑回归模型中，术前白蛋白水平高（比值比4.45）、术后失眠（比值比10.72）和吸烟史（比值比2.91）是谵妄的显著危险因素（P<0.05）。手术前后实验室数据的分析表明，术后发生谵妄的患者术后白蛋白、总蛋白和血红蛋白的下降幅度大于未发生谵妄的患者。这些结果表明，围手术期维持营养状况以及术后早期对睡眠周期的管理对于预防口腔癌切除及游离皮瓣重建术后的谵妄很重要。
