ICU髋部骨折患者术后谵妄的回顾性分析

目的：研究重症监护病房（ICU）髋部骨折患者术詹谵妄的发生率、临床特点及相关危险因素。方法：279例髋部骨折手术患者，67例术后转入ICU。用ICU意识紊乱评估方法（CAM-ICU）进行监测，有7项因素被选作谵妄的危险因素予以分析：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。结果：19例（28．4％）患者在手术后7d内发生谵妻。单因素分析具有统计学意义的变量有既往痴呆史（OR=3．16，95％Cl 1.24～8，15）、术后脱水（OR=3．64，95％cl 1．02～7．44）．合并三个及以上的血管危险因素（OR=3．76，95％cl 1．38～10；53）；多因素回归分析显示具有统计学意义的相关因素有既往痴呆病史（RR=3．06。P=0．014），合并三个及以上的血管危险因素（RR=3．74，P=O．021）。结论：ICU髓部骨折患者手术后谵妄发生率较高，采用CAM-ICU牟亩助诊断和观察．能提高诊断率．骨折前痴呆史、合并三个及以上的血管危险因素是发生手术后谵妄的危险因素。

Clinical Investigation of Postoperative Delirium in Hip-surgery Patients from ICU

Objective： To investigate the incidence and manifestation of postoperative delirium and identify its possible risk factors in hip surgery patients from ICU. Methods： Two hundred and seventy-nine consecutive patients, who underwent hip surgery because of hip fracture were enrolled in the study. Including sixty-seven cases turn to the ICU after surgery.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, hypoxemia. results： Postoperative delirium was detected in 19（28.4%） patients during the first 7 days after surgery. Univariate analysis showed that dementia history lodds 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 multivaUate 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=O.021）. Conclusion： the incidence of ICU delirium of hip surgery patients is high. Use of measurements such as the 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 hip surgery patients from ICU.