接受口腔癌肿瘤切除及重建手术患者的术后谵妄
Postoperative delirium in patients undergoing tumor resection with reconstructive surgery for oral cancer.
作者信息
Takahashi Nozomu, Hiraki Akimitsu, Kawahara Kenta, Nagata Masashi, Yoshida Ryoji, Matsuoka Yuichiro, Tanaka Takuya, Obayashi Yuko, Sakata Junki, Nakashima Hikaru, Arita Hidetaka, Shinohara Masanori, Nakayama Hideki
机构信息
Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan.
Section of Oral Oncology, Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka 814-0193, Japan.
出版信息
Mol Clin Oncol. 2021 Mar;14(3):60. doi: 10.3892/mco.2021.2222. Epub 2021 Jan 24.
Many attempts have been made to identify the risk factors for postoperative delirium, but this has proved difficult due to its complex morbidity. Furthermore, there is little information on postoperative delirium in patients undergoing tumor resection and reconstructive surgery for oral cancer. The aim of the current study was to investigate the incidence of and risk factors for postoperative delirium in patients undergoing resection and reconstructive surgery for oral cancer. The present study included 104 patients with pedicle or free flap reconstruction. Postoperative delirium developed in 22 (21.2%) of these patients. The mean time to onset of postoperative delirium was 2.5±1.0 days and the duration of delirium was 1.9±1.2 days. Univariate analysis demonstrated that the occurrence of postoperative delirium was significantly correlated with operating time (P=0.033), duration of anesthesia (P=0.039), amount of blood loss (P=0.027), method of reconstruction (P=0.008), type of flap used (P=0.009) and time until postoperative ambulation (P=0.0008). Low postoperative red blood cell count (P=0.004), hemoglobin (P=0.004) and hematocrit (P=0.004) were significantly associated with delirium, but preoperative blood test results were not. The multiple logistic regression analysis of these risk factors revealed that the only significant correlation that remained was between postoperative delirium and the time to ambulation after surgery (P=0.005). Since 2009, the Department of Oral and Maxillofacial Surgery, Kumamoto University Hospital has promoted ambulation after the first two postoperative days for patients with oral cancer undergoing tumor resection with reconstruction, and the occurrence of postoperative delirium has decreased from 29.2 to 14.0%. The results of the current study suggest that early postoperative ambulation in patients who undergo reconstructive surgery for oral cancer is effective for preventing postoperative delirium.
人们已经进行了许多尝试来确定术后谵妄的风险因素，但由于其发病机制复杂，这一过程被证明很困难。此外，关于接受口腔癌肿瘤切除和重建手术患者的术后谵妄的信息很少。本研究的目的是调查接受口腔癌切除和重建手术患者术后谵妄的发生率及风险因素。本研究纳入了104例行带蒂或游离皮瓣重建的患者。其中22例（21.2%）患者发生了术后谵妄。术后谵妄的平均发病时间为2.5±1.0天，谵妄持续时间为1.9±1.2天。单因素分析表明，术后谵妄的发生与手术时间（P=0.033）、麻醉持续时间（P=0.039）、失血量（P=0.027）、重建方法（P=0.008）、所用皮瓣类型（P=0.009）以及术后下床活动时间（P=0.0008）显著相关。术后红细胞计数低（P=0.004）、血红蛋白低（P=0.004）和血细胞比容低（P=0.004）与谵妄显著相关，但术前血液检查结果则不然。对这些风险因素进行多因素逻辑回归分析发现，唯一仍然显著的相关性是术后谵妄与术后下床活动时间之间的相关性（P=0.005）。自2009年以来，熊本大学医院口腔颌面外科对接受肿瘤切除并重建的口腔癌患者在术后前两天后促进其下床活动，术后谵妄的发生率已从29.2%降至14.0%。本研究结果表明，接受口腔癌重建手术的患者术后早期下床活动对预防术后谵妄有效。
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