The Analysis Of Risk Factors For Postoperative Delirium Of Free Flap Reconstruction In Patients With Oral And Maxillofacial Malignant Tumor

Postoperative delirium, whose symptoms are disorders of consciousness, cognition, orientation, thoughts, sleep and other aspect, occurs in a few days after general anesthesia. It is a reversible, acute mental disorder syndrome with volatility and usually referred to postoperative mental dysfunction, postoperative cognitive dysfunction.Oral and maxillofacial malignant tumor is an important part of head and neck cancer, which mainly occurrs in the elderly. Its spread pattern is infiltrative growth, making it progress rapidly. Tumor cells metastasize via lymphatic and blood vessels. With the development of medical technology, free flap reconstruction has become a common method for oral and maxillofacial malignant tumor repair. However, surgical trauma may lead to postoperative delirium. Delirium not only affect patients’ recovery and survival of flap, but also bring postoperative nursing more challenges.Objective:This study mainly focus on the factors that before flap surgery, intraoperative flap surgery and postoperative flap surgery of oral and maxillofacial malignant tumor analysis the dangerous element for delirium.Method:We collected 122 patients with malignant tumor, ranging from 40-80 years old and waiting for free flap reconstruction. Using state of consciousness Assessment Method (CAM-CR) evaluate whether patient occur delirium, and devided the risk factors into preoperative factors, intraoperative factors and postoperative factors. Compare the influence of the risk factors of three cases. Using SPSS19.0 and MiniTab17.0 statistical software for statistical data analysis. The data were dealt by single factor analysis. Multi-factors introduct logistic regression analysis. P<0.05 was considered as statistically different.Result:In this study,122 patients ranging from 40 to 80 years old from Oral and Maxillofacial Surgery of Dental Hospital of Shandong Provincial Hospital were involved.13 cases of these maxillofacial malignant tumor patients suffered from postoperative delirium and the rate was 10.7%.In this study, advanced age、alcoholism、gender and sleep disorders, are independent risk factors for delirium. Operation time, free flap location and pain can be proved to cause postoperative delirium.Tracheotomy and postoperative hypoxemia cannot directly result in postoperative delirium. However, these factors make delirium more complex, and may have influence on recovery after operation.Conclusion:1. The elderly is one of the risk factors of delirium for patients after skin flap repair. The regression of stress ability and abnormal metabalism, the reduce of central cholinic neurons and sensory ability maybe the reasons why elderly are more vulnerable.2. Besides, sleep disorders is also one of the risk factors for postoperative delirium. Lack of sleep can affect the mental state of the patient, resulting in cognitive impairment. Thus patients in irritability or anxiety are more vulnerable to postoperative delirium.3. Alcoholism, gender, the position of free flap, operative time, postoperative hypoxemia, postoperative pain failed to prove to be direct causes of postoperative delirium, but these factors make delirium more complex. They are still likely to have impact on postoperative recovery.