扁桃体/腺样体切除术患儿苏醒期谵妄的危险因素分析

Analysis of risk factors for emergence delirium after tonsillectomy/adenoidectomy in preschool children

目的分析扁桃体/腺样体切除术患儿苏醒期谵妄的危险因素。方法选取2022年11月—2023年9月于宁夏医科大学总医院行扁桃体/腺样体切除术的94例患儿,根据术后是否发生苏醒期谵妄分为谵妄组(19例)和非谵妄组(75例)。比较两组患者一般资料及术前实验室参数,对组间比较差异有统计学意义的变量[年龄、淋巴细胞计数、中性粒细胞/淋巴细胞、单核细胞/淋巴细胞、改良耶鲁术前焦虑量表(mYPAS)评分、术后儿童疼痛行为量化评分表(FLACC)评分]进行单因素logistic回归分析,将单因素logistic回归分析中P<0.05的变量纳入多因素logistic回归分析,分析扁桃体/腺样体切除术患儿苏醒期谵妄的独立危险因素。结果94例患儿中有19例(25.3%)发生苏醒期谵妄。谵妄组患儿年龄低于非谵妄组,mYPAS评分、术后FLACC评分>4分的比例高于非谵妄组,术前淋巴细胞计数高于非谵妄组,术前中性粒细胞/淋巴细胞、单核细胞/淋巴细胞低于非谵妄组(均P<0.05);其余一般资料及术前实验室参数差异无统计学意义(均P>0.05)。单因素logistic回归分析结果显示,年龄小[比值比(OR)0.66,95%置信区间(CI)0.445~0.991,P<0.05]、术前淋巴细胞计数高(OR 1.57,95%CI 1.026~2.402,P<0.05)、mYPAS评分高(OR 1.03,95%CI 1.004~1.057,P<0.05)、术后FLACC评分>4分(OR 5.95,95%CI 1.797~19.687,P<0.05)为扁桃体/腺样体切除术患儿苏醒期谵妄的危险因素。多因素logistic回归分析显示,术后FLACC评分>4分(OR 5.32,95%CI 1.470~19.232,P<0.05)是扁桃体/腺样体切除术患儿苏醒期谵妄的独立危险因素。结论扁桃体/腺样体切除术患儿苏醒期谵妄发生率为25.3%。FLACC评分>4分是扁桃体/腺样体切除术患儿苏醒期谵妄的独立危险因素。

Objective To analyze the risk factors of emergence delirium in children after tonsillectomy/adenoidectomy.Methods A total of 94 children who underwent tonsillectomy/adenoidectomy at Ningxia Medical University General Hospital from No‑vember 2022 to September 2023 were selected and divided into a delirium group(n=19)and a non‑delirium group(n=75)according to whether postoperative delirium occurred during the recovery period.Comparing the general information and preoperative laboratory pa‑rameters of the two groups of patients,variables with statistically significant differences between the groups[age,lymphocyte count,neu‑trophils/lymphocytes,monocytes/lymphocytes,modified Yale Preoperative Anxiety Scale(mYPAS)score,postoperative Pain Behavior Quantification Scale for Children(FLACC)score]were subjected to single‑factor logistic regression analysis,and variables with P<0.05 in the single‑factor logistic regression analysis were included in the multi‑factor logistic regression analysis.Analysis of independent risk factors for emergence delirium in children undergoing tonsillectomy/adenoidectomy.Results Nineteen out of 94 children(25.3%)developed emergence delirium.The age of the children in the delirium group was lower than that of the non‑delirium group,the proportion of mYPAS score and postoperative FLACC score>4 points was higher than that of the non‑delirium group,the preoperative lymphocyte count was higher than that of the non‑delirium group,and the preoperative neutrophil/lymphocyte count was higher than that of the non‑delirium group.The numbers of neutrophils/lymphocytes and monocytes/lymphocytes in the blood of patients in the delirium group are lower than those numbers in patients in the non‑delirium group(all P<0.05).There were no statistically significant dif‑ferences in other general information and preoperative laboratory parameters(all P>0.05).The results of single‑factor logistic regression analysis showed that young age[odds ratio(OR)0.66(95%confidence interval(CI)0.445,0.991),P<0.05]and high lymphocyte count[OR 1.57(95%CI 1.026,2.402),P<0.05],high mYPAS score[OR 1.03(95%CI 1.004,1.057),P<0.05],and postoperative FLACC score>4 points[OR 5.95(95%CI 1.797,19.687),P<0.05]are tonsil/Risk factors for emergence delirium in children undergoing adenoidecto‑my.Multivariate logistic regression analysis showed that postoperative FLACC score>4 points[OR 5.32(95%CI 1.470,19.232),P<0.05]is an independent risk factor for emergence delirium in children undergoing tonsillectomy/adenoidectomy.Conclusions The incidence of emerging delirium in children who underwent tonsillectomy/adenoidectomy was 25.3%.FLACC score>4 is an independent risk factor for emergence delirium in children undergoing tonsillectomy/adenoidectomy.