老年食管癌患者行胸腔镜下食管癌根治术后谵妄现状及相关危险因素 ^*

Postoperative delirium and risk factors in elderly patients after thoracoscopic radical resection of esophageal cancer

摘要

目的 结合临床实践经验, 探讨老年食管癌患者行胸腔镜下食管癌根治术后谵妄的发生现状, 并分析影响术后谵妄发生的相关危险因素。方法 选择2024年1月—2025年2月南京医科大学第一附属医院收治的202例老年食管癌患者作为研究对象, 患者均行胸腔镜下食管癌根治术治疗。统计术后谵妄的发生情况, 对术后谵妄发生的影响因素进行单因素分析, 将有统计学意义的指标作为自变量进行多因素logistic回归分析。结果 202例老年食管癌患者中51例术后发生谵妄, 术后谵妄率为25.25%。单因素分析结果显示, 与无谵妄组比较, 谵妄组年龄升高, 饮酒、术后疼痛评分>4分、手术切口方式为三切口、术后低氧血症、合并睡眠障碍占比更高, 麻醉时间更长, 术前1 d焦虑自评量表评分更高, 差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示, 年龄、术后疼痛评分>4分、术后低氧血症、合并睡眠障碍、麻醉时间延长均为老年食管癌患者术后谵妄发生的独立危险因素(P<0.05)。结论 老年食管癌患者行胸腔镜下食管癌根治术后谵妄的发生率较高, 针对年龄升高、术后疼痛评分>4分、术后低氧血症、合并睡眠障碍、麻醉时间延长的老年患者应加以重视, 以降低术后谵妄的发生率。

Abstract

Objective Based on clinical practice, this study aims to explore the current status of postoperative delirium in elderly patients with esophageal cancer after thoracoscopic radical resection of esophageal cancer and analyze the related risk factors. Methods A total of 202 elderly patients with esophageal cancer admitted to the First Affiliated Hospital of Nanjing Medical University from January 2024 to February 2025 were selected as the research subjects. All patients underwent thoracoscopic radical resection of esophageal cancer. The occurrence of postoperative delirium was statistically analyzed, and univariate analysis was conducted on the influencing factors of postoperative delirium. The indicators with statistical significance were used as independent variables for multivariate logistic regression analysis. Results Among the 202 elderly patients with esophageal cancer, 51 cases developed postoperative delirium, with a postoperative delirium rate of 25.25%. Univariate analysis showed that compared with the non-delirium group, the delirium group had higher age, higher proportions of alcohol consumption, postoperative pain score >4 scores, three-port incision, postoperative hypoxemia, and sleep disorders, longer anesthesia time, and higher self-rating anxiety scale score on the day before surgery, and the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that increased age, postoperative pain score >4 scores, postoperative hypoxemia, sleep disorders, and prolonged anesthesia time were independent risk factors for postoperative delirium in elderly patients with esophageal cancer (P<0.05). Conclusion The incidence of postoperative delirium in elderly patients with esophageal cancer after thoracoscopic radical resection of esophageal cancer was relatively high, attention should be paid to elderly patients with increased age, postoperative pain score >4 scores, postoperative hypoxemia, sleep disorders, and prolonged anesthesia time to reduce the incidence of postoperative delirium.

关键词

食管癌 / 胸腔镜下食管癌根治术 / 谵妄 / 危险因素

Key words

Esophageal cancer / Thoracoscopic radical resection of esophageal cancer / Delirium / Risk factors

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基金资助

^*国家自然科学基金资助项目(82201380)