The relationship between intraoperative hypotension and postoperative delirium in patients with cervical intraspinal schwannoma

HE Huali; WANG Pengli; JIANG Jing; YAO Jianhua

doi:10.3969/j.issn.1674-4136.2025.04.011

Abstract：Objective To explore the association between intraoperative hypotension and postoperative delirium(POD)in patients undergoing cervical intraspinal schwannoma resection,and to provide a basis for optimizing perioperative management.Methods A total of 110 patients with cervical intraspinal schwannoma were selected as the research subjects,who underwent schwannoma resection at the Affiliated Hospital of Shaanxi University of Chinese Medicine from January 2019 to January 2024.The research subjects were divided into the POD group and the non-Pod group based on whether Pods occurred.The general and clinical data of the two groups of patients were collected and compared,including mean arterial pressure(MAP),duration of hypotension,minimum MAP value,etc.Multivariate Logistic regression was used to analyze the influencing factors of POD in patients with cervical intraspinal schwannoma and evaluate the relationship between intraoperative hypotension and POD.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive efficacy of intraoperative hypotension for the occurrence of POD in patients with cervical intraspinal schwannoma.Results Among the 110 patients,a total of 20 patients developed POD,including 12 cases of inhibitory activity,5 cases of hyperactive type,and 3 cases of mixed type.There were statistically significant differences between the POD group and the non-POD group in terms of cerebrovascular history,duration of hypotension,and minimum MAP value(P<0.05).The results of multivariate regression analysis showed that the history of cerebrovascular disease(OR=2.330,95%CI:2.224-2.437)and the duration of intraoperative hypotension(OR=1.982,95%CI:1.892-2.072)are independent risk factors for POD in patients with cervical intraspinal schwannoma,and minimum MAP value(OR=0.524,95%CI:0.062-0.986)is a protective factor for POD in patients with cervical intraspinal schwannoma.The ROC curve showed that the area under the curve(AUC)for the duration of intraoperative hypotension and minimum MAP value was 0.794 and 0.772,respectively(95%CI:0.752-0.812,0.747-0.802),and the AUC for combined detection was 0.869(95%CI:0.853-0.897,and the Delong test results showed that the combined diagnostic efficacy was superior to that of a single indicator(Z=2.162,P=0.008).Conclusions Among patients undergoing surgery for intraspinal schwannoma of the cervical spinal canal,the duration of intraoperative hypotension and the amplitude of MAP fluctuation are independent risk factors for POD.The lowest MAP value is a protective factor for POD,and the predictive efficacy of combined detection is higher than that of single detection.Perioperative MAP can be used as an auxiliary indicator to assess the risk of POD occurrence in patients with cervical intraspinal schwannoma.