PNI和SII与头颈癌患者术后谵妄的相关性研究

Correlation analysis of prognostic nutritional index and systemic immune-inflammatory index with postoperative delirium in head and neck cancer patients

目的:研究头颈癌(head and neck cancer,HNC)患者术后谵妄(postoperative delirium,POD)的发病率和危险因素,并探讨预后营养指数(prognostic nutritional index,PNI)、系统免疫炎症指数(systemic immune-inflammation index,SII)与HNC患者POD的相关性。方法:回顾性收集徐州市中心医院2017年1月~2023年5月行根治术联合颈淋巴结清扫术的HNC患者206例,其中男126例,女80例;年龄27~89岁,平均(60.80±12.51)岁。分析POD相关危险因素,Logistic回归筛选独立危险因素。结果:POD发病率为14.1%(29/206)。单因素分析:年龄≥60岁、性别、肿瘤部位、吸烟、PNI、SII、总蛋白、气管切开、输血、游离皮瓣移植、手术时间、术后发热、睡眠障碍、视觉模拟(visual analogue scale,VAS)疼痛评分、ICU监护时间、肺炎、皮瓣危象、住院时间差异具有统计学意义(P<0.05);多因素Logistic回归分析:年龄≥60岁(OR=6.381,95%CI 1.218~33.421)、PNI(OR=0.793,95%CI 0.649~0.970)、SII(OR=1.002,95%CI 1.000~1.003)、输血(OR=7.551,95%CI 1.180~48.320)、睡眠障碍(OR=7.411,95%CI 1.067~51.482)、VAS疼痛评分(OR=1.648,95%CI 1.016~2.674)、ICU监护时间(OR=3.879,95%CI 1.399~10.753)是POD的独立危险因素。结论:PNI和SII对头颈癌患者术后POD预测价值良好,可用于临床评估POD发生风险,具有成为临床筛选POD高危患者新的常规工具的可能。

Objective:To investigate the incidence and risk factors of postoperative delirium(POD)after in patients with head and neck cancer(HNC)and explore the correlation between prognostic nutritional index(PNI)and systemic immune-inflammation index(SII)with POD in head and neck cancer patients.Methods:A retrospective analysis of 206 patients in who were performed the radical resection with cervical lymph node dissection for HNC in the Xuzhou Central Hospital between January 2017 to May 2023.Of the 206 patients,126 were male and 80 were female,aged 65~79 years with a mean of(60.80±12.51)years.Analysis of POD-related risk factors with SPSS 26.0 software package,and Logistic regression was used to screen for independent risk factors.Results:A total of 29(14.1%)patients had postoperative delirium.Single factor analysis results indicated that delirium was associated with age≥60 years old,male,tumor site,smoking,PNI,SII,total protein,tracheostomy,blood transfusion,free flap reconstruction,time of operation,postoperative fever,sleep disturbance,ICU monitoring time,pneumonia,flap crisis,visual analogue scale/scores(VAS),length of hospital stay.Multiple logistic regression analysis showed that the independent risk factors of delirium included age≥60 years old(OR=6.381,95%CI 1.218~33.421),PNI(OR=0.793,95%CI 0.649~0.970),SII(OR=1.002,95%CI 1.000~1.003),transfusion(OR=7.551,95%CI 1.180~48.320),sleep disturbance(OR=7.411,95%CI 1.067~51.482),ICU monitoring time(OR=3.879,95%CI 1.399~10.753),VAS scores(OR=1.648,95%CI 1.016~2.674).Conclusion:PNI and SII have good predictive values for POD in head and neck cancer patients,and it can be used to screen high-risk patients of POD.They have the potential to become a new routine tool for identifying patients who at high risk of POD.