头颈部肿瘤重建手术后谵妄的危险因素：一项回顾性临床试验。

Risk Factors of Delirium Following Reconstructive Surgery for Head and Neck Tumors: A Retrospective Clinical Trial.

作者信息

Li Lulan, Zhang Liupan, Wu Xixuan, Zeng Zhenhua

机构信息

Department of Critical Care Medicine, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.

Department of Internal Medicine, Zhongshan Shenwan Hospital, Zhongshan, People's Republic of China.

出版信息

Ther Clin Risk Manag. 2025 Jan 24;21:81-91. doi: 10.2147/TCRM.S480272. eCollection 2025.

DOI:10.2147/TCRM.S480272

PMID:39876888

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11774114/

Abstract

BACKGROUND

Patients after head and neck tumor reconstruction surgery frequently require deep sedation and analgesia in the ICU. However, the risk factors for delirium associated with propofol-based sedation remain unclear.

OBJECTIVE

The study aimed to explore the risk factors of delirium of propofol singled or combined sedation.

METHODS

This retrospective study analyzed ICU patients who underwent head and neck tumor reconstruction surgery. The patients were divided into three groups: propofol (P), propofol + midazolam (PM), and propofol + dexmedetomidine (PD) groups. We utilized univariate and multivariate logistic regression to identify risk factors of delirium.

RESULTS

Delirium occurred in 4 (7.02%), 11 (28.21%), and 5 (20.83%) patients in the P, PM and PD groups, respectively. Elevated mean arterial pressure (MAP), increased aspartate aminotransferase (AST) levels, and the combined use of midazolam were determined to be significant risk factors for delirium in this patient cohort. The combined use of midazolam is the strongest predictor of delirium, which can increase the risk of delirium by 3.218 times (95% CI = 1.041-9.950, p = 0.042).

CONCLUSION

Propofol combined with midazolam for sedation in patients after head and neck tumor reconstruction surgery may increase the risk of delirium.

摘要

背景

头颈部肿瘤重建手术后的患者在重症监护病房（ICU）常常需要深度镇静和镇痛。然而，与丙泊酚镇静相关的谵妄危险因素仍不清楚。

目的

本研究旨在探讨丙泊酚单药或联合镇静时谵妄的危险因素。

方法

这项回顾性研究分析了接受头颈部肿瘤重建手术的ICU患者。患者被分为三组：丙泊酚组（P）、丙泊酚+咪达唑仑组（PM）和丙泊酚+右美托咪定组（PD）。我们采用单因素和多因素逻辑回归分析来确定谵妄的危险因素。

结果

P组、PM组和PD组谵妄发生例数分别为4例（7.02%）、11例（28.21%）和5例（20.83%）。平均动脉压（MAP）升高、天冬氨酸转氨酶（AST）水平升高以及咪达唑仑的联合使用被确定为该患者队列中谵妄的显著危险因素。咪达唑仑的联合使用是谵妄最强的预测因素，可使谵妄风险增加3.218倍（95%CI = 1.041 - 9.950，p = 0.042）。