老年髋部骨折围手术期谵妄状态的临床分析

目的讨论老年髋部骨折住院患者围手术期谵妄状态的发病率、发病的高危因素,临床表现、临床分型,诊断、治疗及预防措施。方法回顾分析上海交通大学附属同仁医院骨科2012年1月~2014年12月年老年髋部骨折手术的病例共386例,其中出现临床谵妄状态的有26例。分析其发病的高危因素、临床表现、谵妄状态的分型、诊断、治疗及预防措施。结果 3年内围手术期谵妄患者发病率为6.7%。其中谵妄活跃型22例,占85%;谵妄安静型4例,占15%;入院后行髋部骨折手术治疗前发生谵妄5例,占19%;术后第1~4天发生21例,占81%。经临床综合治疗后谵妄症状明显改善,未出现严重不良反应;用药期间均未发现明显的椎体外系反应、低血压、Q-T间期延长等短暂反应,总体恢复良好。结论围手术期谵妄在老年髋部骨折围手术期中有较高发病率,临床上应加强了解和认识,加强与相关科室如老年科及麻醉科等学科的合作,改善老年髋部骨折患者的手术治疗效果及预后。

Clinical analysis of delirious state in 26 elderly hip fracture patients during perioperative period

Objective To discuss the incidence,risk factors,clinical features,classifications,diagnosis,treatment and preventive measures of delirious state in 26 elderly hip fracture patients during perioperative period.Methods Totally 386 elderly hip fracture patients who were operated in Shanghai Tongren Hospital from Jan.2012 to Dec.2014 were reviewed.Twenty-six patients developed clinical delirious state.The incidence,risk factors,clinical features,classifications,diagnosis,treatment and preventive measures of delirious state in these patients were analyzed.Results The incidence of delirious state in elderly hip fracture patients during perioperative period was 6.7% in three years.Among them,22 cases (85%) were active type and 4 cases (15%) were quiet type.Five cases (19%) occurred before the operation.Twenty-one cases (81%) occurred in 1-4 days after the operation.The symptoms of delirium were relieved by comprehensive clinical treatment.Severe complications such as obviously extrapyramidal reactions,hypotension,Q-T interphase extension did not occur during the therapy.The overall recovery was good.Conclusion The results suggest that the delirious state in elderly hip fracture patients during perioperative period has a high incidence.The actions such as strengthening the awareness of this state,reducing the high risk factors,uniting the geriatrics and anesthesiology department can be taken to reduce the incidence of the delirious state,which is beneficial to improve the effect and prognosis of surgical treatment.