老年髋关节置换术患者术后认知功能障碍的临床特点及影响因素分析

目的研究65岁以上行髋关节置换术患者术后认知功能障碍的临床特点及影响因素。方法 101例患者在术前1 d~3 d和术后7 d进行MMSE量表测定,收集患者的一般资料、年龄、性别、受教育时间、既往病史、手术时间、失血量、麻醉方式。采用多因素Logistic逐步回归分析POCD发生的影响因素,P0.05为差异有统计学意义。结果 101例患者发生POCD者16例,发生率为15.84%,POCD组患者的年龄显著大于非POCD组(OR=1.238,95%CI 1.103~1.248,P0.05),POCD组中全麻患者显著多于非POCD组(OR=1.215,95%CI 1.003~8.72,P0.05)。结论临床工作中对于高龄、全麻的髋部骨折患者应该多关注术后认知功能变化,及时进行相关量表筛查,尽早发现、尽早干预。

Clinical features and risk factors of postoperative cognitive dysfunction in elderly patients undergoing hip Arthroplasty

Objective To determinate the clinical features and risk factors of postoperative cognitive dysfunction in patients aged at least 65 years undergoing hip arthroplasty.Methods A total of 101 patients aged at least 65 years undergoing hip arthroplasty were enrolled in this prospective study.Each patient underwent MMSE test which were administere 1 day~3 days before surgery,on the 7th day after surgery.Patients general information was documented.Past history,operation time,bleeding,anesthesia were recorded.A multivariable logistic stepwise regression was used to identify risk factors of POCD.Results The incidence of POCD after hip arthroplasty was 15.84%.The age of patients with POCD was significantly greater than those without POCD.The general anesthesia in POCD group was significantly greater than those without POCD.(OR=1.238,95%CI 1.103~1.248,P<0.05) and (OR=1.215,95%CI 1.003~8.72,P<0.05).Multivariable logistic stepwise regression analysis showed that age and general anesthesia were risk factors of POCD.Conclusion For elderly,general anesthesia patients undergoing hip arthroplasty.We should more concern about the change of their cognitive functionfunction.POCD patients need early diagnosis and early intervention.