高龄髋部骨折患者术后谵妄的高危因素分析

目的探讨高龄髋部骨折患者发生术后谵妄的高危因素。方法 75岁以上老年髋部骨折手术患者122例纳入研究。术前采用简易智力状态检查量表评价患者认知功能水平,术后7d内每日采用精神错乱评估方法对患者进行术后谵妄诊断,6项因素被选作术后谵妄的危险因素加以分析：年龄＆gt;85岁、术前认知功能障碍、全麻、是否在伤后72h内手术、术后低氧血症、使用静脉镇痛泵。结果 52例（42.6%）患者在手术后7d内发生谵妄,其中活动过度型26例（50.0%）,活动减退型14例（26.9%）,混合型12例（23.1%）。单因素分析谵妄与非谵妄组间具有统计学差异的因素有术前认知功能障碍（OR=3.02,95%CI1.28-9.32）、全麻（OR=2.55,95%CI 1.07-8.12）、受伤72h后手术（OR=2.31,95%CI 1.05-7.82）和术后低氧血症（OR=1.83,95%CI 1.02-6.49）。多因素回归分析得到具有统计学意义的相关因素有术前认知功能障碍（RR=2.68,P=0.026）、全麻（RR=2.30,P=0.031）和受伤72h后手术（RR=2.14,P=0.041）。结论高龄髋部骨折患者术后谵妄发生率高,术前存在认知功能障碍、全麻和受伤72h后进行手术是发生术后谵妄的高危因素。

Analysis on the risk factors of postoperative delirium in aged hip fracture patients

Objective To investigate the risk factors of postoperative delirium in aged hip fracture patients. Methods Totally 122 patients who aged greater than 75 years and underwent hip fracture repair surgery were involved into this study. Before surgery, mini-mental state examination （ MMSE ） was applied to evaluate the cognitive function. Confusion assessment methods （ CAM ） were applied to diagnose delirium in the first week after surgery. Six factors were investigated ： age 〉 85 years, preoperative cognitive impairment, general anesthesia, whether surgery was performed within 72 hours after injury, postoperative hypoxemia, whether intravenous analgesic pump was used after surgery. Results Postoperative delirium was observed in 52 patients（ 42. 6% ） in the first 7 days after surgery, containing hyperactive type in 26 patients （50. 0% ） ,hypoactive type in 14 patients （26. 9% ）, mixed type in 12 patients （ 23.1% ）. According to the univariate analysis, preoperative cognitive impairment （ OR = 3.02,95 % CI 1.28-9. 32 ） , general anesthesia（ OR = 2. 55,95% CI 1.07-8. 12 ） , surgery was not performed within 72 hours after injury（ OR = 2. 31,95 % CI 1.05-7.82 ） , postoperative hypoxemia （ OR = 1.83,95 % CI 1.02-6. 49 ） were risk factors. According to the multivariate analysis, preoperative cognitive impairment（ RR = 2. 68 ,P = 0. 026） , general anesthesia（ RR = 2. 30,P = 0. 031 ） , surgery was not performed within 72 hours after injury （ RR = 2. 14, P = 0. 041 ） were significant risk factors for postoperative delirium. Conclusion The incidence of postoperative delirium is high in aged hip fracture patients. Preoperative cognitive impairment, general anesthesia,surgery was not performed within 72 hours after injury are significant risk factors.