重症监护病房髋部骨折患者术后谵妄的回顾性分析

目的探讨重症监护病房（ICU）髋部骨折术后谵妄的发生率及相关危险因素。方法选择髋部骨折手术后转人ICU的67例，采用ICU意识紊乱评估方法进行监测，针对骨折前痴呆史、合并血管危险因素、贫血、低蛋白血症、脱水、电解质紊乱、低氧血症等7项谵妄的危险因素进行分析。结果本组19例（28．4％）术后6d内发生谵妄，单因素分析有统计学意义的变量为既往痴呆病史（OR=3．16，95％CI1．24～8．15）、术后脱水（OR=3．64，95％CI 1．02～7．44）、合并三个及以上的血管危险因素（OR=3．76，95％CI1．38～10．53）；多因素回归分析有统计学意义的相关因素为既往痴呆病史（RR=3．06，P=0．014）、合并三个及以上的血管危险因素（RR=3．74，P=0．021）。结论ICU髋部骨折术后谵妄发生率较高，骨折前痴呆病史、合并三个及以上的血管危险因素、低体重指数是术后发生谵妄的高危因素。

Clinical Investigation of Postoperative Delirium in ICU Patients Undergoing Hip-Surgery

Objective To investigate the incidence rate and manifestations of postoperative delirium and identify its possible risk factors in ICU patients undergoing hip surgery.Methods 67 consecutive patients,who underwent hip surgery and turned to ICU because of hip fracture were enrolled in the study.The delirium was identified by CAM-ICU.Possible risk factors for delirium including dementia before hip fracture,vascular risk factor,anemia,hypoproteinemia,dehydration,electrolyte disturbance and hypoxemia were anaylzed.Results Postoperative delirium was detected in 19(28.4%) patients during the first 7 days after surgery.Univariate analysis showed that dementia history [odds ratio(OR)=3.16,95%CI 1.24-8.15],dehydration(OR=3.64,95%CI 1.02-7.44),with three or more vascular risk factors(OR=3.76,95%CI 1.38-10.53) were risk factors(P<0.05).According to multivatiate analysis,significant risk factors for the development of ICU delirium were dementia history(RR=3.06,P=0.014),with three or more vascular risk factors(RR=3.74,P=0.021).Conclusion The incidence rate of ICU delirium in hip surgery patients is high.CAM-ICU for delirium can enhance the detection of delirium in hip surgery patients.Risk factors like dementia,with three or more vascular risk factors are associated with postoperative delirium in ICU patients undergoing hip-surgery.