老年患者髋部手术后发生急性精神障碍的风险因素分析  

Analysis on the risk factor of postoperative mental state changes of the elderly after hip surgery

作　　者：陈炜[1] 张军[1] 左镇华[1] 

机构地区：[1]武警北京总队第二医院外二科,北京100037

出　　处：《武警后勤学院学报（医学版）》2013年第9期805-808,共4页Journal of Logistics University of PAP（Medical Sciences）

摘　　要：【目的】探讨老年患者髋部手术后发生急性精神障碍的发病率及相关风险因素。【方法】回顾性分析本院2年内收治的150例行髋部手术的老年患者的临床资料,根据术后精神障碍发病情况分为2组,比较分析2组年龄因素、麻醉用药量、术中minMAP、血ALB、ACTH等资料。【结果】150例中发病16例,发病率10.7%。患病组与非患病组在年龄、minMAP、术中麻黄碱用量、血ALB、ACTH等因素的比较呈现显著性差异(P<0.05)。【结论】老年患者髋部手术后急性精神障碍与老年人海马组织退变、肾上腺皮质功能相对不全、应激功能障碍、术中低血压低灌注等因素有关。术中有效管理,防止低血压及应用糖皮质激素治疗可以预防和治疗术后急性精神障碍。[ Objective ]To discuss the incidence and related factors of postoperative mental state changes of the elderly after hip surgery. [ Methods] Clinical data of 150 routine hip surgeries of the elderly were analyzed retrospectively. The date were divided into 2 groups according to the conditions of postoperative mental state changes to compare the age factors, anaesthetic dosage, and minMAP, blood ALB, ACTH during surgery. [ Result] 16 cases of mental state changes was found in the 150 cases, the incidence rate was 10.7%. The diseased group and non-diseased group were distinctively different in age, minMAP, as well as the ephedrine dosage, blood ALB, ACTH during surgery （P〈 0.05）. [Conclusion] The postoperative mental state changes of the elderly after hip surgery is related to hippocampal degeneration, relative adrenal insufficiency, stress dysfunction and hypotension hypoperfusion. It can be prevented by effectively avoiding hypotension during surgery and treated by applying glucocorticoid.

关 键 词：老年 髋部手术 急性精神障碍 海马退变 麻醉管理 

分 类 号：R749.2[医药卫生—神经病学与精神病学]