To Analyze The Risk Factors Of Delirium After Radical Resection Of Esophageal Carcinoma

Objective:To explore the risk factors of delirium after radical resection of esophageal cancer,and to screen out controllable risk factors,so as to provide theoretical support for clinical medical staff to carry out early identification and intervention,and to provide reference basis for preventing and reducing the occurrence of delirium after radical resection of esophageal cancer.Methods:According to the criteria of inclusion and exclusion,a current situation investigational study was conducted to analyze 100 patients who underwent radical resection of esophageal cancer in the Intensive Care unit(ICU)of a hospital in Changchun,Jilin Province from October 2018 to June 2020.Patients were put under intravenous inhalation combined anesthesia.1.Postoperative delirium risk factors questionnaire was used to collect relevant information and data.This questionnaire consisted of the following components.Pre-operative data of patients was collected such as gender,age,Body Mass Index(BMI),past history(hypertension,coronary heart disease,diabetes,etc.),smoking,alcohol consumption,educational level,marital status,residence,etc.,were collected.Data of intraoperative conditions,such as anesthesia time,operative time,surgical incision,intraoperative blood loss,intraoperative blood transfusion.Data of postoperative conditions such as hemoglobin,albumin,blood electrolyte level,pain score,hypoxemia,etc.2.In order to examine how the above risk factors influence postoperative delirium and evaluation of the levels and types of postoperative delirium patients were experiencing needed to be determined.This was done using the following diagnostics.The level of sedation was evaluated according to Richmond Agitation-Sedation Scale(RASS).Intensive Care Delirium Screening Checklist(ICDSC)was used to confirm the diagnosis of Delirium and divide the Delirium group and the non-delirium group.The types of delirium were determined according to the sedation degree of agitation and sedation scale.Delirium assessment began on the second day after the patient was transferred to the ICU,twice a day,and the delirium assessment stopped after he patient was transferred out of the ICU.In addition to direct observational measures,patients’body mass index was calculated using the formula(BMI)=weight/height(kg/m~2),and postoperative pain was assessed using the Prince-Henry Pain Scale(PHPS).3.SPSS18.0 statistical software was used for analysis.The measurement capital was expressed as mean standard deviation()or the interval between median and interquad.dependent sample t test or rank sum test was used for comparison between the groups.Enumeration data were expressed as n(%),and the chi-square test or Fisher’s exact test was used for comparison.Univariate analysis was used to analyze the related factors of delirium after radical resection of esophageal cancer.statistically significant correlation factors were substituted into logistic regression analysis to identify independent risk factors for postoperative delirium after radical resection of esophageal cancer.Two-sided test and the test levelα=0.05 were used,with P<0.05was considered statistically significant.Results:1.From October 2018 to June 2020,delirium was evaluated in 100 patients who met the inclusion criteria after radical resection of esophageal cancer,and 48 patients were screened out of delirium.The incidence of delirium after radical resection of esophageal cancer was 48.0%.2.Univariate analysis showed that there was statistically significant difference in the following factors(P<0.05).Surgical factors:anesthesia time(z=2.346,P=0.019),operative time(t=2.332,P=0.022),surgical incision(χ~2=10.240,P=0.006),intraoperative blood transfusion(P=0.049).Laboratory examination related factors:hemoglobin(t=6.602,P<0.0001),albumin(t=4.632,P<0.0001),potassium ions(t=2.032,P=0.045),calcium ions(z=4.007,P<0.0001),magnesium ions(z=2.306,P=0.021)were statistically significant.Pain related factors:pain score=4(χ~2=47.657,P<0.0001).Other related factors:hypoxemia(χ~2=16.188,P<0.0001).There was no significant statistical significance(P>0.05)between POD group and non-POD group in gender,age,BMI,previous history,smoking,alcohol consumption,education level,marital status,residence,intraoperative blood loss,blood sodium,chloride,carbon dioxide binding force(CO2CP),phosphorus.3.Multivariate Logistic regression analysis results showed that hemoglobin(P=0.0002,OR=0.91,95%CI:0.86～0.95)and pain score=4(P<0.001,OR=0.02,95%CI:0.003～0.089)were directly related to the occurrence of postoperative delirium after radical resection of esophageal cancer.Conclusion:1.Risk factors for postoperative delirium after radical resection of esophageal cancer includ:(1)Surgical factors:anesthesia time,operation time,surgical incision,intraoperative blood transfusion.(2)Laboratory examination related factors:hemoglobin,albumin,potassiumion,calciumion,magnesiumion.(3)Pain related factors:pain score=4.(4)Other related factors:hypoxemia.2.Postoperative low hemoglobin and pain score=4 are classified as an independent risk factor for delirium after radical resection of esophageal cancer.