Study On Risk Factors Of Delirium In Elderly Patients Undergoing Thoracoscopic Radical Resection Of Lung Cancer

Objective: To study the incidence of postoperative delirium in patients undergoing thoracoscopic radical resection of lung cancer and explore its related risk factors.The aim is to reduce the incidence of postoperative delirium in high-risk patients and improve the prognosis of high-risk patients through early intervention.Methods: Select 185 elderly patients who underwent elective thoracoscopic radical resection of lung cancer in the Thoracic Surgery Department of Handan Central Hospital from January 2019 to October 2020,and record their general data,preoperative data,and intraoperative data for each selected patient.Data and post-operative data.With the occurrence of postoperative delirium as the outcome variable,the influence of the above statistical indicators on postoperative delirium was explored.Perform single factor analysis on the above statistical indicators.In order to include as many statistical indicators as possible,perform multivariate analysis.In the single factor analysis,the P value is set to 0.10,and then the statistically significant indicators are substituted into the multivariate Logistic regression model for analysis Determine the independent risk factors,and then calculate and analyze the ROC area of the continuous variables in the independent risk factors to get the best cut-off value to get the high-risk factors.Results: Among the 185 patients,21 patients(11.3%)developed postoperative delirium.The results of univariate analysis showed the patient’s general information(age,BMI,history of COPD),preoperative data(ASA classification,preoperative hemoglobin level,FEV1,FEV1/predicted value,arterial CO2 partial pressure),intraoperative data(operation time,anesthesia)Time,intraoperative one-lung ventilation time,intraoperative blood loss,number of intraoperative blood transfusions,and propofol dosage)and postoperative data(postoperative hemoglobin level,postoperative dezocine dosage)were statistically significant(P<0.10),the results of multivariate analysis showed that age,BMI,ASA grade,history of COPD,intraoperative one-lung ventilation time,propofol dosage,and postoperative dezocine dosage were independent risk factors(P<0.05).The continuous variables of independent risk factors were shown by ROC area results: age AUC=0.780,intraoperative one-lung ventilation time AUC=0.735,ASA classification AUC=0.719,body mass index(BMI)AUC=0.412,postoperative dezocine Dosage AUC=0.544.Among them,age,intraoperative one-lung ventilation time,ROC area of ASA classification>0.7,the best cut-off age is 72.1 years,ASA classification isⅢ,and intraoperative one-lung ventilation time is 91.76 min.Conclusion: Age,BMI,ASA classification,chronic obstructive pulmonary disease(COPD),intraoperative one-lung ventilation time,propofol dosage and postoperative dezocine dosage are independent of postoperative delirium in elderly patients undergoing thoracoscopic radical resection of lung cancer risk factors.For patients who are ≥ 72.1 years old,ASA grade ≥ Ⅲ,and intraoperative one-lung ventilation time ≥91.76 min,expect to adjust the patient’s general state before surgery,reduce the one-lung ventilation time during the operation,reduce the incidence of postoperative delirium,and improve the patient the prognosis.