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目的筛选肿瘤细胞减灭术联合腹腔内热灌注化疗术后谵妄发生的危险因素。方法全麻下行肿瘤细胞减灭术联合腹腔内热灌注化疗患者150例,年龄18~75岁,性别不限,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,体重40~70 kg。根据术后72小时内是否发生谵妄分为谵妄组和非谵妄组。记录患者性别、年龄、体重、ASA分级、术前空腹血糖和糖化血红蛋白;既往史包括肿瘤切除术史、化疗和放疗史;合并症包括抑郁症、高血压、冠状动脉粥样硬化性心脏病、慢性主观性头晕、慢性阻塞性肺疾病、腔隙性脑梗死和慢性肾功能衰竭;手术相关因素包括腹腔内热灌注时间、手术时间和术后机械通气时间;术后镇痛补救情况。将组间比较差异有统计学意义的因素进行多因素Logistic回归分析,筛选术后谵妄发生的危险因素。结果 139例患者中42例发生术后谵妄,发生率为30.2%。Logistic回归分析结果显示,年龄≥65岁、术前抑郁、长时间腹腔内热灌注化疗和术后ICU长时间机械通气是肿瘤细胞减灭术联合腹腔内热灌注化疗术后谵妄的独立危险因素。结论年龄≥65岁、术前抑郁、长时间腹腔内热灌注化疗和术后ICU长时间机械通气是肿瘤细胞减灭术联合腹腔内热灌注化疗术后谵妄的独立危险因素。
Objective To screen the risk factors of delirium after cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy. Methods Totally 150 patients underwent total cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy under general anesthesia. The age ranged from 18 to 75 years. There were no gender differences. The American Society of Anesthesiologists (ASA) was classified as grade Ⅰ ~ Ⅲ and weighed 40 ~ 70 kg. According to whether the occurrence of delirium within 72 hours after surgery is divided into delirium group and non-delirium group. Patient’s sex, age, weight, ASA grade, preoperative fasting plasma glucose, and HbA1c were recorded; past history includes history of tumor resection, history of chemotherapy and radiotherapy; comorbidities include depression, hypertension, coronary heart disease, Chronic subjective dizziness, chronic obstructive pulmonary disease, lacunar infarction and chronic renal failure; operative factors include intraperitoneal hot perfusion time, operation time and postoperative mechanical ventilation; postoperative analgesic recovery. Multivariate Logistic regression analysis was used to compare the statistically significant factors among the groups, and the risk factors of postoperative delirium were screened. Results Of the 139 patients, 42 cases had postoperative delirium, with a rate of 30.2%. Logistic regression analysis showed that preoperative depression, long-term intraperitoneal hyperthermic perfusion chemotherapy and postoperative ICU prolonged mechanical ventilation were independent risk factors for delirium after cytoreductive surgery and intraperitoneal hyperthermic perfusion chemotherapy. Conclusions Preoperative depression, prolonged intraperitoneal hyperthermic perfusion chemotherapy and postoperative ICU prolonged mechanical ventilation are independent risk factors for delirium after cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy.