Objective: To investigate the risk factors for delirium after free flap reconstruction surgery in elderly patients with head and neck cancer. Methods: 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 (n=75) and a non-delirium group (n=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 P<0.05 were included in a multivariate Logistic regression model to screen for independent risk factors for delirium. Results: 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 (OR=2.802, P=0.005), perioperative sleep disturbances (OR=7.104, P<0.001), and moderate-to-severe postoperative pain (OR=6.903, P<0.001) were risk factors for postoperative delirium. Conclusions: Male gender, perioperative sleep disturbances, and moderate-to-severe postoperative pain are independent risk factors for delirium in these patients.
目的： 探讨老年患者头颈癌游离皮瓣修复术发生术后谵妄（POD）的危险因素。 方法： 回顾性收集2018年1月至2022年12月于广西医科大学口腔医学院·附属口腔医院手术麻醉科行头颈癌游离皮瓣修复术的309例老年患者的临床资料，其中男性197例（63.8%），女性112例（36.2%），年龄（66.8±5.5）岁，根据美国《精神疾病诊断与统计手册》第5版的谵妄诊断标准评估患者术后1周内是否发生POD，将患者分为POD组和非POD组。通过病历系统采集与POD可能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、围术期睡眠障碍、手术方式、术中出入量、麻醉用药量、术后疼痛等，并将P<0.05的变量纳入多因素Logistic回归模型中，筛选出谵妄的独立危险因素。 结果： 老年患者头颈癌游离皮瓣修复术后，谵妄发生率为24.3%（75/309），POD组75例患者，非POD组234例患者。多因素Logistic回归分析结果显示，男性（OR=2.802，P=0.005）、围术期睡眠障碍（OR=7.104，P<0.001）和术后出现中重度疼痛（OR=6.903，P<0.001）是患者发生POD的危险因素。 结论： 男性、围术期睡眠障碍和术后出现中重度疼痛是老年患者头颈癌游离皮瓣修复术后发生谵妄的独立危险因素。.