Obermeier Katharina Theresa, Kraus Moritz, Smolka Wenko, Henkel Jochen, Saller Thomas, Otto Sven, Liokatis Paris
Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, 80337 Munich, Germany.
Musculoskeletal University Center Munich, Department of Orthopaedics and Trauma Surgery, University Hospital, LMU Munich, 80539 Munich, Germany.
Cancers (Basel). 2022 Jun 28;14(13):3176. doi: 10.3390/cancers14133176.
Squamous cell carcinoma (SCC) is a malignant tumor derived from squamous cells and can be found in different localizations. In the oral cavity especially, it represents the most common type of malignant tumor. First-line therapy for oral squamous cell carcinoma (OSCC) is surgery, including tumor resection, neck dissection, and maybe reconstruction. Although perioperative mortality is low, complications such as delirium are very common, and may have long-lasting consequences on the patient's quality of life. This study examines if excessive fluid administration, among other parameters, is an aggravating factor for the development of postoperative delirium. A total of 198 patients were divided into groups concerning the reconstruction technique used: group A for primary wound closure or reconstruction with a local flap, and group B for microsurgical reconstruction. The patients with and without delirium in both groups were compared regarding intraoperative fluid administration, fluid balance, and other parameters, such as blood loss, duration of surgery and overall ventilation, alcohol consumption, and creatinine, albumin, natrium, and hematocrit levels. The logistic regression for group A shows that fluid intake ( = 0.02, OR = 5.27, 95% CI 1.27-21.8) and albumin levels ( = 0.036, OR = 0.22, CI 0.054-0.908) are independent predictors for the development of delirium. For group B, gender ( = 0.026, OR = 0.34, CI 0.133-0.879) with a protective effect for females, fluid intake ( = 0.003, OR = 3.975, CI 1.606-9.839), and duration of ventilation ( = 0.025, OR = 1.178, CI 1.021-1.359) are also independent predictors for delirium. An intake of more than 3000 mL for group A, and 4150 mL for group B, increases the risk of delirium by approximately five and four times, respectively. Fluid management should be considered carefully in patients with OSCC, in order to reduce the occurrence of postoperative delirium. Different factors may become significant for the development of delirium regarding different surgical procedures.
鳞状细胞癌（SCC）是一种源自鳞状细胞的恶性肿瘤，可发生于不同部位。尤其是在口腔中，它是最常见的恶性肿瘤类型。口腔鳞状细胞癌（OSCC）的一线治疗方法是手术，包括肿瘤切除、颈部清扫术，可能还包括重建手术。虽然围手术期死亡率较低，但诸如谵妄等并发症却非常常见，并且可能对患者的生活质量产生长期影响。本研究探讨了除其他参数外，过量补液是否是术后谵妄发生的一个加重因素。总共198名患者根据所采用的重建技术被分为不同组：A组为一期伤口缝合或采用局部皮瓣重建，B组为显微外科重建。对两组中发生谵妄和未发生谵妄的患者在术中补液、液体平衡以及其他参数方面进行比较，这些参数包括失血量、手术时长、总通气时间、酒精摄入量以及肌酐、白蛋白、钠和血细胞比容水平。A组的逻辑回归分析表明，液体摄入量（P = 0.02，OR = 5.27，95% CI 1.27 - 21.8）和白蛋白水平（P = 0.036，OR = 0.22，CI 0.054 - 0.908）是谵妄发生的独立预测因素。对于B组，性别（P = 0.026，OR = 0.34，CI 0.133 - 0.879）对女性有保护作用，液体摄入量（P = 0.003，OR = 3.975，CI 1.606 - 9.839）以及通气时长（P = 0.025，OR = 1.178，CI 1.021 - 1.359）也是谵妄的独立预测因素。A组液体摄入量超过3000 mL，B组超过4150 mL时，谵妄风险分别增加约五倍和四倍。对于OSCC患者，应谨慎考虑液体管理，以减少术后谵妄的发生。对于不同的手术方式，不同因素可能对谵妄的发生具有显著影响。
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