Postoperative delirium in patients undergoing tumor resection with reconstructive surgery for oral cancer
Postoperative delirium in patients undergoing tumor resection with reconstructive surgery for oral cancer
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DOI：
10.3892/mco.2021.2222
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发表时间：
2021-03-01
影响因子：
1.2
通讯作者：
Nakayama, Hideki
中科院分区：
文献类型：
--
作者：
Takahashi, Nozomu;Hiraki, Akimitsu;Nakayama, Hideki
人们已经多次尝试确定术后谵妄的风险因素，但由于其复杂的发病情况，这已被证明是困难的。此外，关于口腔癌肿瘤切除和重建手术患者术后谵妄的信息很少。本研究的目的是调查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）以及术后开始活动的时间（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，但术前血液检测结果与之无关。对这些风险因素进行的多元逻辑回归分析显示，唯一仍然显著相关的是术后谵妄与术后开始活动的时间（P = 0.005）。自2009年以来，熊本大学医院口腔颌面外科促进口腔癌肿瘤切除重建患者在术后前两天后开始活动，术后谵妄的发生率从29.2%降至14.0%。本研究结果表明，口腔癌重建手术患者术后早期活动对预防术后谵妄是有效的。
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.