术前血浆总胆固醇水平预测食管癌切除患者术后谵妄的价值

doi:10.3969/j.issn.1006-5725.2025.07.011

Abstract

Abstract:

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.

Key words: total cholesterol, esophageal cancer, postoperative delirium, model prediction, older adults, blood fat

CLC Number:

R614

Shengrun GAO,Chen LI,Liang WANG,Kezhong LI,Na LIU,Chengjie GAO,Yun LI. To explore the application value of preoperative plasma total cholesterol level in predicting postoperative delirium in patients with esophageal cancer resection[J]. The Journal of Practical Medicine, 2025, 41(7): 1004-1009.

Figures/Tables 4

Tab.1

Comparison of preoperative and intraoperative conditions between non delirium group and delirium group"

项目	非谵妄（n = 163）	谵妄组（n = 24）	t/Z/χ ² 值	P值
年龄［M（P₂₅，P₇₅）］/岁	64（58，71）	69（65，76.75）	-2.274	0.023
性别/［例（%）］			1.429	0.232
男	125（76.69）	21（87.50）
女	38（23.31）	3（12.50）
BMI（x ± s）/（kg/m²）	22.52 ± 3.27	22.21 ± 3.25	-0.433	0.666
ASA分级/［例（%）］			0.094	0.759
Ⅱ级	146（89.57）	21（87.50）
Ⅲ级	17（10.43）	3（12.50）
器质性心脏病或冠心病比率/［例（%）］	13（7.98）	6（25.00）	6.642	0.010
高血压/［例（%）］	44（26.99）	9（37.50）	1.137	0.286
糖尿病/［例（%）］	13（7.98）	1（4.17）	0.438	0.508
心律失常/［例（%）］	30（18.40）	7（29.17）	1.527	0.217
贫血/［例（%）］	30（18.40）	5（20.83）	0.081	0.776
低蛋白血症比率/［例（%）］	9（5.52）	1（4.17）	0.076	0.783
总胆固醇（x ± s）/（mmol/L）	4.571 ± 0.607	3.878 ± 0.739	-5.068	0.000
甘油三酯［M（P₂₅，P₇₅）］/（mmol/L）	0.980（0.75，1.18）	0.82（0.585，1.125）	-1.866	0.062
高密度脂蛋白［M（P₂₅，P₇₅）］/（mmol/L）	1.100（0.96，1.28）	1.150（0.948，1.323）	-1.544	0.123
低密度脂蛋白（x ± s）/（mmol/L）	2.915 ± 0.687	2.575 ± 0.652	-2.277	0.024
载脂蛋白A1［M（P₂₅，P₇₅）］/（g/L）	1.17（1.02，1.28）	1.10（1.001，1.29）	-0.800	0.424
载脂蛋白B（x ± s）/（g/L）	0.846 ± 0.231	0.811 ± 0.218	-0.682	0.496
麻醉方式/［例（%）］			0.042	0.838
全麻	126（77.30）	19（79.17）
全麻联合肋间神经阻滞	37（22.70）	5（20.83）
手术方式/［例（%）］			0.207	0.649
胸腔镜	76（46.63）	10（41.67）
非胸腔镜	87（53.37）	14（58.33）
使用右美托咪定/［例（%）］	117（71.78）	6（25.00）	20.336	0.000
麻醉时间（x ± s）/min	295.56 ± 82.54	334.25 ± 79.49	2.153	0.033
手术时间（x ± s）/min	268.42 ± 81.39	300.54 ± 82.22	1.803	0.073
术中最低平均MAP（x ± s）/mmHg	69.02 ± 7.74	60.88 ± 6.78	-4.889	0.000
术中最低HR（x ± s）/（次/min）	60.28 ± 7.56	61.00 ± 8.47	0.428	0.669
术中出血量［M（P₂₅，P₇₅）］/mL	100（100，200）	100（100，288）	-1.177	0.239

Tab.1

Tab.2

Tab.3

Fig.1

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项目	非谵妄组（n = 163）	谵妄组（n = 24）	Z/χ ² 值	P值
转入ICU/［例（%）］	0（0）	4（16.67）	27.76	0.000
术后住院时间［M（P₂₅，P₇₅）］/d	12（10，15）	21（11，43）	-3.017	0.003
术后30 d内死亡/［例（%）］	0（0）	3（12.50）	20.707	0.000

项目	β	标准误差	瓦尔德	显著性	OR值	95% CI
年龄	0.051	0.038	1.793	0.181	1.052	0.977 ~ 1.133
总胆固醇	-1.628	0.688	5.600	0.018	0.196	0.051 ~ 0.756
低密度脂蛋白	0.285	0.627	0.206	0.650	1.329	0.389 ~ 4.539
冠心病	-0.124	0.855	0.021	0.884	0.883	0.165 ~ 4.716
右美托咪定	1.797	0.638	7.938	0.005	6.029	1.728 ~ 21.038
麻醉时长	0.007	0.004	3.855	0.050	1.007	1.000 ~ 1.015
最低平均动脉压	-0.191	0.051	13.943	0.000	0.826	0.747 ~ 0.913

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To explore the application value of preoperative plasma total cholesterol level in predicting postoperative delirium in patients with esophageal cancer resection

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