A Prospective Study Of Perioperative Risk Factors And Incidence Of Postoperative Delirium In Patients With Gastrointestinal Malignancy

Purpose:The incidence of Postoperative Delirium in patients with gastrointestinal malignant tumors and its perioperative risk factors were explored,and then high risk patients with Postoperative Delirium（POD）were identified,so as to achieve early detection,early diagnosis and early treatment in these patients,and strengthen perioperative anesthesia management.Method:A total of 332 patients who underwent elective resection of gastrointestinal malignant tumors from 2019 to 2020 were collected.Patients with audiovisual dysfunction,patients with low cognitive level,patients who could not use the drug used in the trial for various reasons,and patients who refused to be evaluated for delirium were excluded.After entering the room,venous access was established,and basic vital signs heart rate（HR）,electrocardiogram（ECG）,pulse oxygen saturation（SpO₂）,blood pressure（SBP/DBP/MAP）were monitored.Radial artery catheterization was performed,and a urethral catheter was placed before surgery.Inhale fresh air for 6L/min,take 3 deep breaths and breathe calmly for 5min.Anesthesia induction was performed with propofol 2mg/kg,cisatracurium 0.15-0.20mg/kg,sufentanil 0.4ug/kg,gently placed into an endotracheal catheter,connected to the anesthesia machine to control ventilation.Inhalation of 2%sevoflurane（or continuous infusion of 4～12mg/kg/h with propofol）,infusion of 0.02～0.2ug/kg/min with remifentanil,intraoperative entropy index was maintained at 40～60,and noradrenaline was applied to maintain the stability of circulation.After surgery,the patient was sent to the anesthesia recovery room,and the endotracheal tube was pulled out as indicated by extubation,and the patient was transferred to the ward when he was fully awake.General patient information[gender,age,body mass index（BMI）]was recorded.Preoperative data[Chalsen comorbidities index,preoperative nutritional status,mini-mental State examinationExamination,MMSE),history of psychiatric nervous system disease,ASA classification,smoking and drinking history,preoperative albumin level,preoperative hematocrit level,preoperative blood potassium,blood sodium and blood glucose level],Intraoperative data（maintenance mode of intraoperative anesthesia,duration of intraoperative hypotension,duration of operation,amount of intraoperative blood loss,amount of intraoperative fluid transfusion）,and postoperative data（level of postoperative potassium,sodium,blood glucose,postoperative albumin,postoperative hematocrit,postoperative self-controlled analgesia）.Delirium was assessed by a trained professional 1 to 7 days postoperatively at 2 p.m.using the CAM scale.Result:1.A total of 36 cases（11.6%）in this group had POD,of which 29 cases had POD within 3 days after operation.2.The analysis of statistical results shows that the potential factors of gastrointestinal cancer POD are:advanced age,low BMI index,more preoperative comorbid diseases,high ASA grade,previous history of neuropsychiatric diseases,perioperative albumin reduction,perioperative period Hematocrit is small,perioperative blood glucose is unstable,perioperative blood potassium is abnormal,anesthesia operation time is long,intraoperative fluid supplement and loss are more,intraoperative blood transfusion,and intraoperative hypotension occur for a long time.3.Logistic regression analysis showed that the independent risk factors for POD were:advanced age,high ASA grade,long anesthesia time,long intraoperative hypotension,high postoperative blood glucose level,and previous history of neurological diseases.Among them,a previous history of neuropsychiatric diseases（OR=25.281）is the most important independent risk factor for postoperative delirium derived from this trial.Conclusion:This group of case reports shows that the incidence of postoperative delirium in patients with gastrointestinal malignancies is 11.6%,and the incidence is still high,and most of them occur within 3 days.The occurrence of POD is related to many factors in the perioperative period,prompting us to pay attention to perioperative anesthesia management,and identify high-risk patients prone to POD as early as possible in the perioperative period,so as to implement precise anesthesia and reduce the occurrence of POD.