首页|口腔癌游离皮瓣移植术后谵妄的相关因素及影响研究

口腔癌游离皮瓣移植术后谵妄的相关因素及影响研究

Correlation analysis of prognostic nutritional index and systemic immune inflammatory index and postoperative delirium in patients undergoing flaps surgery of oral cavity cancer

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目的 研究口腔癌(oral cavity cancer,OCC)患者游离皮瓣移植术后谵妄(postoperative delirium,POD)的发病率和危险因素,并探讨预后营养指数(prognostic nutritional index,PNI)、系统免疫炎症指数(system immune inflammation index,SII)与OCC患者POD的相关性.方法 回顾性收集徐州市中心医院 2016 年 1 月—2023 年 5 月行游离皮瓣移植术且资料完整的OCC患者 138 例,其中男 89 例,女 49 例;年龄 27～88 岁,平均(60.04±10.89)岁.用SPSS 26.0 软件包分析POD相关危险因素,Logistic回归筛选独立危险因素并建立预测模型,以受试者的工作曲线(ROC)下面积(AUC)及最佳临界值时的敏感度和特异度检验模型效果.结果 POD发病率为 10.9%(15/138).单因素分析:年龄≥60 岁、PNI、SII、总蛋白、手术时间、气管切开、术中输血、术后睡眠障碍、ICU监护时间、视觉模拟(visual analogue scale,VAS)疼痛评分、术后并发症具有统计学意义(P＜0.05);多因素Logistic回归分析:年龄≥60 岁、PNI、SII、输血、睡眠障碍、疼痛是 POD 的独立危险因素.PNI＜50.075,SII＞754.308时POD风险升高;PNI&SII-预测模型AUC=0.919,约登指数为 0.689,灵敏度=0.933,特异度=0.756.结论 PNI和SII是OCC皮瓣患者POD的独立危险因素,可作为预测POD发生的指标.PNI&SII-预测模型对OCC皮瓣患者POD具有较好的预测价值,可用于指导临床早期干预与治疗.
Objective To investigate the incidence and risk factors of postoperative delirium(POD)after free flap reconstruction in patients with oral cavity cancer(OCC)and explore the correlation between prognostic nutritional index(PNI)and system immune in-flammation index(SII)with POD in oral cavity cancer patients.Methods A retrospective analysis of 138 patients who underwent the free flap surgery for OCC in Xuzhou Central Hospital between January 2016 to March 2023 were performed.Eighty-nine were male and 49 were female.The average age was(60.04±10.89)years(range:27 to 88).POD-related risk factors were analyzed with SPSS 26.0 software package.The association between risk factors and POD was analyzed by binary Logistic regression analysis.The effect of PNI and SII was evaluated using the area under the receiver operating characteristic curve(AUC-ROC),sensitivity and specificity.Results A total of 15(10.9%)patients had POD.Single factor analysis results indicated that delirium was associated with age≥60,PNI,SII,total protein,time of operation,tracheostomy,blood transfusion,sleep disturbance,ICU observation time,visual analogue scale(VAS)pain score and complications.Multiple Logistic regression analysis showed that the independent risk factors of delirium included age≥60,PNI,SII,blood transfusion,sleep disturbance and pain.The risk of POD was increased when PNI＜50.075 and SII＞754.308.AUC of the PNI&SII-prediction model was 0.919;Youden index was 0.689;sensitivity was 0.933 and specificity was 0.756.Conclu-sion PNI and SII are independent risk factors for POD and can be used as indicators to predict POD.The PNI&SII-prediction model has a good value for POD in patients with flaps for OCC,and can be used to clinically guide early intervention and treatment.

oral cavity cancerdeliriumprognostic nutritional indexsystem immune inflammation indexprediction model

沈梦圆、张雪莹、徐欣晨、李晓东、孟箭

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蚌埠医学院研究生院,安徽蚌埠(233000)

徐州市中心医院口腔科,江苏徐州(221000)

口腔癌 谵妄 预后营养指数 系统免疫炎症指数 预测模型

国家口腔疾病临床医学研究中心开放课题徐州市科技计划项目徐州医科大学附属医院优秀人才基金项目徐州医科大学附属医院优秀人才基金项目

NCRCO-202101KC21187XYFY2020035XYFY202207

2024

10.13591/j.cnki.kqyx.2024.04.005

口腔医学
南京医科大学口腔医学院

口腔医学

CSTPCD
影响因子：0.641
ISSN：1003-9872
年,卷(期)：2024.44(4)
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