目的 探讨术前血浆总胆固醇水平预测食管癌切除术后谵妄（postoperative delirium，POD）的价值，分析其危险因素。 方法 回顾性收集2019年1月到2023年12月具有完整POD救治记录、完成食管癌切除术的187例患者的围术期完整电子病历资料。根据1周内发生POD情况，将其分为谵妄组和非谵妄组。绘制术前血浆总胆固醇水平预测食管癌切除POD受试者工作特征曲线，并计算曲线下面积及95%可信区间，计算并取约登指数最大值所对应血浆总胆固醇水平为最佳临界值。 结果 187例接受食管癌切除的患者中有24例发生POD，发病率为12.83%。谵妄组较非谵妄组年龄偏高，术中血压、血浆总胆固醇、低密度脂蛋白水平偏低，麻醉时间更长，冠心病是其危险因素，右美托咪定可以减少POD的发生。术前血浆总胆固醇水平预测POD的ROC曲线下面积、95%可信区间、临界值、灵敏度和特异度分别为0.761、0.657 ~ 0.865、≤ 4.11 mmol/L、70.8%和77.3%。 结论 非高脂血症患者中，术前血浆总胆固醇水平偏低、术中低血压是食管癌切除POD的独立危险因素，术前血浆总胆固醇水平对POD具有中等预测价值。

Objective To investigate the predictive value of preoperative plasma total cholesterol levels for postoperative delirium （POD） following esophagectomy and to analyze its associated risk factors. Methods The complete perioperative electronic medical records of 187 patients with POD who underwent esophagectomy at the 960 Hospital of the People's Liberation Army between January 2019 and December 2023 were retrospectively analyzed. According to the occurrence of POD within one week postoperatively， the patients were categorized into a delirium group and a non?delirium group. The preoperative plasma total cholesterol levels were used to construct a receiver operating characteristic （ROC） curve for predicting delirium after esophagectomy. The area under the curve （AUC） and its 95% confidence interval （CI） were calculated. Additionally， the plasma total cholesterol level corresponding to the maximum Youden index （sensitivity + specificity?1） was determined as the optimal critical value. Results POD occurred in 24 of 187 patients who underwent esophageal cancer resection， with an incidence rate of 12.83%. Compared to the non?delirium group， the delirium group exhibited older age， lower intraoperative blood pressure， lower plasma total cholesterol and low?density lipoprotein levels， longer anesthesia duration， and a higher prevalence of coronary heart disease， which was identified as a risk factor for POD. Dexmedetomidine administration was associated with a reduced occurrence of POD. The AUC， 95%CI， cut?off value， sensitivity， and specificity of preoperative plasma total cholesterol level for predicting POD were 0.761， 0.657 ~ 0.865， ≤ 4.11 mmol/L， 70.8%， and 77.3%， respectively. Conclusions Among non?hyperlipidemic patients， low preoperative plasma total cholesterol levels and intraoperative hypotension are identified as independent risk factors for POD following esophageal cancer resection. Preoperative plasma total cholesterol levels exhibit moderate predictive value for the occurrence of POD.