头颈部肿瘤重建手术后谵妄的危险因素：回顾性临床试验。

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2025-01-24 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S480272

Lulan Li, Liupan Zhang, Xixuan Wu, Zhenhua Zeng

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引用次数: 0

摘要

背景：头颈部肿瘤重建术后患者在ICU经常需要深度镇静镇痛。然而，与基于异丙酚的镇静相关的谵妄的危险因素仍不清楚。目的：探讨异丙酚单独或联合镇静引起谵妄的危险因素。方法：回顾性分析ICU收治的头颈部肿瘤重建术患者。患者分为三组：丙泊酚(P)组、丙泊酚+咪达唑仑（PM）组和丙泊酚+右美托咪定（PD）组。我们采用单因素和多因素logistic回归来确定谵妄的危险因素。结果：P、PM、PD组谵妄发生率分别为4例（7.02%）、11例（28.21%）、5例（20.83%）。平均动脉压（MAP）升高、谷草转氨酶（AST）水平升高以及联合使用咪达唑仑被确定为该患者谵妄的重要危险因素。联合使用咪达唑仑是谵妄的最强预测因子，可使谵妄的发生风险增加3.218倍（95% CI = 1.041 ~ 9.950, p = 0.042）。结论：异丙酚联合咪达唑仑用于头颈部肿瘤重建术后患者镇静可增加谵妄的发生风险。

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Risk Factors of Delirium Following Reconstructive Surgery for Head and Neck Tumors: A Retrospective Clinical Trial.

Background: Patients after head and neck tumor reconstruction surgery frequently require deep sedation and analgesia in the ICU. However, the risk factors for delirium associated with propofol-based sedation remain unclear.

Objective: The study aimed to explore the risk factors of delirium of propofol singled or combined sedation.

Methods: This retrospective study analyzed ICU patients who underwent head and neck tumor reconstruction surgery. The patients were divided into three groups: propofol (P), propofol + midazolam (PM), and propofol + dexmedetomidine (PD) groups. We utilized univariate and multivariate logistic regression to identify risk factors of delirium.

Results: Delirium occurred in 4 (7.02%), 11 (28.21%), and 5 (20.83%) patients in the P, PM and PD groups, respectively. Elevated mean arterial pressure (MAP), increased aspartate aminotransferase (AST) levels, and the combined use of midazolam were determined to be significant risk factors for delirium in this patient cohort. The combined use of midazolam is the strongest predictor of delirium, which can increase the risk of delirium by 3.218 times (95% CI = 1.041-9.950, p = 0.042).

Conclusion: Propofol combined with midazolam for sedation in patients after head and neck tumor reconstruction surgery may increase the risk of delirium.

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.