口腔癌游离皮瓣移植术后谵妄的相关因素及影响研究

doi:10.13591/j.cnki.kqyx.2024.04.005

摘要/Abstract

摘要：

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。

关键词: 口腔癌, 谵妄, 预后营养指数, 系统免疫炎症指数, 预测模型

Abstract:

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 inflammation 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. Conclusion 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.

Key words: oral cavity cancer, delirium, prognostic nutritional index, system immune inflammation index, prediction model

中图分类号:

R782.053

沈梦圆, 张雪莹, 徐欣晨, 李晓东, 孟箭. 口腔癌游离皮瓣移植术后谵妄的相关因素及影响研究[J]. 口腔医学, 2024, 44(4): 261-267.

SHEN Mengyuan, ZHANG Xueying, XU Xinchen, LI Xiaodong, MENG Jian. Correlation analysis of prognostic nutritional index and systemic immune inflammatory index and postoperative delirium in patients undergoing flaps surgery of oral cavity cancer[J]. Stomatology, 2024, 44(4): 261-267.

图/表 4

表1

138例OCC患者POD的危险因素分析结果"

相关因素	谵妄(n=15)	非谵妄(n=123)	合计	发病率/%	检验值	P
术前变量
年龄[例(%)]					卡方检验	0.019^*
≥60岁	12(80.0)	59(48.0)	71	16.9	χ²=5.492
<60岁	3(20.0)	64(52.0)	67	4.5
性别[例(%)]					卡方检验	0.184
男	12(80.0)	77(62.6)	89	13.5	χ²=1.767
女	3(20.0)	46(37.4)	49	6.1
高血压[例(%)]					连续修正	0.653
是	3(20.0)	36(29.3)	39	7.7	卡方检验
否	12(80.0)	87(70.7)	99	12.1	χ²=0.202
肿瘤部位[例(%)]					Fisher确切	0.484
舌	4(26.7)	51(41.5)	55	7.3	概率法
口底	2(13.3)	7(5.7)	9	22.2
牙龈	3(20.0)	29(23.6)	32	9.4
颊	4(36.7)	25(20.3)	29	13.8
其他(颌骨、口咽、唇)	2(13.3)	11(8.9)	13	15.4
BMI/(kg/m²)($\bar{x}±s$)	24.40±2.71	23.72±3.19			t=0.796	0.428
PNI($\bar{x}±s$)	46.73±12.80	51.56±5.30			Z=2.004	0.045^*
SII	878.05±647.62	521.27±357.24			Z=3.130	0.002^*
总蛋白/(g/L)($\bar{x}±s$)	62.20±10.26	67.98±6.18			Z=2.545	0.011^*
术中变量
手术时间/min	569.67±140.48	491.18±143.83			t=2.000	0.047^*
淋巴结清扫方式					连续修正	0.295
根治性颈淋巴结清扫术	11(73.3)	73(59.3)	84	13.1	卡方检验
功能性颈淋巴结清扫术	3(20.0)	23(18.7)	26	13.0	χ²=2.442
选择性颈淋巴结清扫术	1(6.7)	27(22.0)	28	3.7
皮瓣类型					连续修正	0.412
下肢皮瓣	9(60.0)	60(48.8)	69	13.0	卡方检验
前臂皮瓣	2(13.3)	35(28.5)	37	5.4	χ²=1.774
胸大肌皮瓣	4(26.7)	28(22.8)	32	12.5
气管切开[例(%)]					连续修正	0.048^*
是	14(93.3)	79(66.7)	93	15.1	卡方检验
否	1(6.7)	44(33.3)	45	2.2	χ²=3.915
输血[例(%)]					卡方检验	0.010^*
是	12(80.0)	55(44.7)	67	17.9	χ²=6.664
否	3(20.0)	68(55.3)	71	4.2
术后变量
睡眠障碍[例(%)]					卡方检验	0.004^*
是	13(86.7)	58(47.2)	71	18.3	χ²=8.356
否	2(13.3)	65(52.8)	67	3.0
肺炎[例(%)]					连续修正	0.004^*
是	9(60.0)	27(22.0)	36	25.0	卡方检验
否	6(40.0)	96(78.0)	102	5.9	χ²=8.162
皮瓣危象[例(%)]					连续修正	0.001^*
是	7(46.7)	13(10.6)	20	35.0	卡方检验
否	8(53.3)	110(89.4)	118	6.8	χ²=11.296
ICU监护时间/d($\bar{x}±s$)	1.60±0.63	1.15±0.62			Z=3.332	0.001^*
VAS评分($\bar{x}±s$)	3.13±1.64	2.37±0.93			Z=2.284	0.022^*
住院时间/d($\bar{x}±s$)	27.40±4.14	23.80±4.61			t=2.880	0.005^*

表1

表2

图1

图2

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自变量	β	SE	Wald	P	OR(95%CI)
年龄	2.261	1.092	4.285	0.038	9.593(1.128~81.604)
PNI	0.170	0.086	3.906	0.048	0.843(0.712~0.999)
SII	0.002	0.001	4.484	0.034	1.002(1.000~1.004)
输血	2.035	1.035	3.865	0.049	7.653(1.006~58.198)
睡眠障碍	2.227	1.044	4.550	0.033	9.274(1.198~71.787)
VAS	0.985	0.415	5.618	0.018	2.677(1.186~6.041)