颅内肿瘤开颅术后双侧额部积气与术后谵妄的相关性研究

Correlation study of bilateral frontal pneumocephalus and postoperative delirium after intracranial tumor craniotomy

目的探讨颅内肿瘤开颅术后双侧额部积气与术后谵妄之间的关系。方法回顾性分析2018年3—8月首都医科大学附属北京天坛医院重症医学科连续常规监测治疗的594例颅内肿瘤开颅术后的成年患者的临床资料。患者于术后第1天进行谵妄评估,以术后是否发生谵妄将患者分为谵妄组和非谵妄组。并收集术后谵妄评估前的相关临床资料和出院时的转归资料;根据术后12 h内的头颅CT诊断双侧额部积气,以是否存在双侧额部积气将患者分为双侧额部积气组和无双侧额部积气组。进行术后谵妄的单因素和多因素logistic回归分析后,根据术后谵妄的影响因素应用倾向性评分法进行1∶1匹配,分析双侧额部积气与术后谵妄的相关性。结果594例患者中,91例(15.3%)术后发生谵妄。多因素logistic回归分析显示,双侧额部积气是术后谵妄的独立危险因素(OR=1.94,95%CI:1.03~3.67,P=0.041)。594例患者中,有190例(32.0%)患者发生双侧额部积气。应用倾向性评分成功匹配出163对患者。与无双侧额部积气组比较,双侧额部积气组患者术后谵妄的发生率明显升高[分别为11.7%(19/163)、24.5%(40/163),P=0.003]、术后住院天数延长[M(Q_(1),Q_(3))分别为9(8,12)d、11(8,14)d,P=0.016]。结论术后谵妄在颅内肿瘤开颅手术患者中具有较高的发生率且与不良转归相关。双侧额部积气可能是术后谵妄的重要危险因素。

Objective To investigate the relationship between bilateral frontal pneumocephalus and postoperative delirium following craniotomy for intracranial tumors.Methods A retrospective analysis was conducted on 594 adult patients with intracranial tumors after craniotomy who were routinely monitored and treated in the Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University from March to August 2018.The patients were evaluated for delirium using the Confusion Assessment Method for the ICU(CAM-ICU)on the 1st postoperative day,and the patients were divided into a delirium group and a non-delirium group according to the occurrence of postoperative delirium.Relevant clinical data before postoperative delirium assessment and outcome data at discharge were collected.According to the diagnosis of bilateral frontal pneumocephalus based on head CT within 12 hours after operation,the patients were divided into two groups according to the presence or absence of bilateral frontal pneumocephalus:bifrontal pneumocephalus group and non-bifrontal pneumocephalus group.After univariate and multivariate logistic analyses of postoperative delirium,propensity score matching(1∶1)was conducted to assess the relationship between bi-frontal pneumocephalus and postoperative delirium according to the influencing factors of postoperative delirium.Results Of the 594 patients,91(15.3%)developed postoperative delirium.Multivariate logistic regression analysis showed that bilateral frontal pneumocephalus was an independent risk factor for postoperative delirium(OR=1.94,95%CI:1.03-3.67,P=0.041).Of the 594 patients,190(32.0%)patients developed bilateral frontal pneumocephalus.Using the propensity score,163 pairs of patients were successfully matched.Compared with the group without bilateral frontal pneumocephalus,the incidence of postoperative delirium was higher[11.7%(19/163)vs.24.5%(40/163),P=0.003]and postoperative hospital stay was longer[M(Q_(1),Q_(3)):9(8,12)d vs.11(8,14)d,P=0.016]in the bilateral frontal pneumocephalus group.Conclusions Postoperative delirium has a high incidence in patients undergoing craniotomy for intracranial tumors and is associated with poor outcomes.Bilateral frontal pneumocephalus may be an important risk factor for postoperative delirium.