Chen S X, Qin F Y, Yu X M, Huang Y J, Zhou S N, Gu W P, Chen Q M
Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University, Nanning530021, China.
Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University & Guangxi Clinical Research Center for Craniofacial Deformity, Nanning530021, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2025 Jan 9;60(1):54-60. doi: 10.3760/cma.j.cn112144-20240907-00339.
To investigate the risk factors for delirium after free flap reconstruction surgery in elderly patients with head and neck cancer. This study retrospectively collected clinical data from 309 elderly patients with head and neck cancer who underwent radical resection and free flap reconstruction surgery in the Department of Operation & Anesthesiology, College & Hospital of Stomatology, Guangxi Medical University from January 2018 to December 2022. Among them, there were 197 males (63.8%) and 112 females (36.2%), with an average age of (66.8±5.5) years old. Based on the delirium diagnostic criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, patients were evaluated for postoperative delirium within one week after surgery. They were then divided into a delirium group (=75) and a non-delirium group (=234). Perioperative indicators potentially related to postoperative delirium, including age, gender, past medical history, tumor characteristics, hematological tests, perioperative sleep disturbances, surgical procedures, intraoperative fluid intake and output, anesthetic dosage, postoperative pain, etc, were collected from the relevant medical record system.Variables with <0.05 were included in a multivariate Logistic regression model to screen for independent risk factors for delirium. The incidence of delirium after free flap reconstruction surgery for head and neck cancer in elderly patients was 24.3% (75/309). Multivariate Logistic regression analysis showed that male gender (=2.802, =0.005), perioperative sleep disturbances (=7.104, <0.001), and moderate-to-severe postoperative pain (=6.903, <0.001) were risk factors for postoperative delirium. Male gender, perioperative sleep disturbances, and moderate-to-severe postoperative pain are independent risk factors for delirium in these patients.
探讨老年头颈癌患者游离皮瓣重建术后谵妄的危险因素。本研究回顾性收集了2018年1月至2022年12月在广西医科大学附属口腔医院手术麻醉科接受根治性切除及游离皮瓣重建手术的309例老年头颈癌患者的临床资料。其中，男性197例（63.8%），女性112例（36.2%），平均年龄（66.8±5.5）岁。根据《精神障碍诊断与统计手册》第五版中概述的谵妄诊断标准，在术后1周内对患者进行术后谵妄评估。然后将他们分为谵妄组（n = 75）和非谵妄组（n = 234）。从相关病历系统中收集可能与术后谵妄相关的围手术期指标，包括年龄、性别、既往病史、肿瘤特征、血液学检查、围手术期睡眠障碍、手术方式、术中液体出入量、麻醉剂量、术后疼痛等。将P<0.05的变量纳入多因素Logistic回归模型，以筛选谵妄的独立危险因素。老年头颈癌患者游离皮瓣重建术后谵妄的发生率为24.3%（75/309）。多因素Logistic回归分析显示，男性（OR = 2.802，P = 0.005）、围手术期睡眠障碍（OR = 7.104，P<0.001）和中重度术后疼痛（OR = 6.903，P<0.001）是术后谵妄的危险因素。男性、围手术期睡眠障碍和中重度术后疼痛是这些患者谵妄的独立危险因素。
