老年骨科患者术后精神障碍影响因素分析  

Influencing factors analysis of postoperative delirium in the elderly with bone pain

作　　者：潘秋宁 宣懂 林智[1] 

机构地区：[1]湛江中心人民医院,广东湛江524037

出　　处：《现代医药卫生》2014年第12期1781-1782,1784,共3页Journal of Modern Medicine & Health

摘　　要：目的探讨老年骨科患者术后精神障碍的影响因素及临床特点。方法选取该院2010年10月至2013年8月收治的120例行骨科手术老年患者,对术后发生急性精神障碍(A组,n=15)及未发生急性精神障碍(B组,n=105)患者的临床资料进行分析,比较两组患者基础病情、麻醉方式、术中低氧血症及手术时间等因素对术后精神障碍的影响。结果 120例患者中共15例发生术后急性精神障碍,发生率为12.5%。A组冠心病、高血压、亚临床甲状腺功能减低患病率高于B组,差异均有统计学意义(P<0.05)。A组硬膜外麻醉患者术后精神障碍发生率[6.67%(2/30)]显著低于全身麻醉患者[14.44%(13/90)],差异有统计学意义(P<0.05);A组患者与B组比较,围术期出血量显著增加,血清钠、血清钙血细胞比容及术后血红蛋白显著下降,且电解质失衡,差异均有统计学意义(P<0.05);两组患者血清钾血细胞比容、手术时间比较,差异无统计学意义(P>0.05)。结论临床上应高度重视老年患者术后精神障碍的发生,实施预见性干预措施可有效预防术后精神障碍的发生或避免其导致的不良后果。Objective To investigate the influencing factors and clinical characteristics of postoperative delirium in the elderly with bone pain. Methods Totally 120 patients with orthopedic surgery received in the hospital from October 2010 to August 2013 were selected and analyzed on the clinical data of the patients with postoperative mental disorder （group A,n=15） and without postoperative delirium（group B,n=105）. The influences of anesthesia, intra-operative hypoxemia and operation time on postoperative delirium in the two groups were compared. Results Among the 120 patients,15 had postoperative acute mental disorder with the incidence rate of 12.5%. The incidence rate of coronary heart disease ,high blood pressure and hypothyroidism of group A was higher than that of group B,which had statistical difference（P〈0.05）;The incidence rate of postoperative mental disorder of the patients with epidural anesthesia[6.67%（2/30）] was lower than those with general anesthesia [14.44%（13/90）]. The difference was statically significant（P〈0.05）;Compared with group B,the bleeding amount during the perioperative period increased,while the serum natrium and serum calcium hematocrit as well as hemoglobin fell with electrolyte imbalance ,which had statistical difference（P〈0.05）;The comparison of serum potassium hematocrit and operation time had no statistically significant difference（P〈0.05）. Conclusion Much attention should be paid on postoperative delirium in the elderly in the clinic ,predictable intervention measures could be effective in preventing the occurrence of postoperative delirium or avoiding adverse consequences.

关 键 词：精神障碍 手术后期间 老年人 骨科术后 影响因素 

分 类 号：R749.2[医药卫生—神经病学与精神病学]