我国老年患者术后谵妄危险因素的系统评价  

Risk Factors of Postoperative Delirium in Elderly Patients in China: A Systematic Review

作　　者：袁晓丽[1] 江智霞[1] 宋凌霞[1] 杨莉[1] 何英[1] 罗公印[1] 

机构地区：[1]遵义医学院附属医院护理部,贵州省遵义市563003

出　　处：《中国全科医学》2015年第10期1197-1202,共6页Chinese General Practice

基　　金：贵州省国际科技合作计划项目(黔科合外G字[2010]7033号);遵市科合社字(2014)65号

摘　　要：目的探讨我国老年患者术后谵妄的危险因素,为临床制定干预措施提供依据。方法检索万方数据资源系统、中国期刊全文数据库(CNKI)、维普信息资源系统(VIP),收集建库至2013年12月公开发表的关于老年患者术后谵妄危险因素研究文献,按纳入和剔除标准进行筛选,采用Rev Man 5.2软件对病例对照文献进行Meta分析,对病例总结文献统计各危险因素的发生率。结果共纳入16篇文献,其中病例对照8篇,病例总结8篇。病例对照文献累计病例353例、对照2 008例。老年术后谵妄各因素合并OR值(95%CI)分别为:低氧血症2.58(1.59,4.18)、合并肺部感染4.76(1.36,16.67)、合并高血压2.16(1.20,3.89)、合并冠心病1.50(0.82,2.73)、术后疼痛3.18(1.63,6.20)、全身麻醉3.64(0.94,14.11)、手术时间32.30(-37.67,102.27)、高龄(≥70岁)0.99(-0.46,2.45)。Meta分析结果显示,低氧血症、合并肺部感染、合并高血压、术后疼痛是老年患者术后谵妄的危险因素(P<0.05)。病例总结文献累计病例共404例,其中低氧血症、合并高血压的发生率较高,分别为62.6%(253例)、55.9%(226例)。结论术前合并高血压、肺部感染,术后低氧血症、疼痛是老年患者术后谵妄的危险因素。Objective To systematically review the risk factors of postoperative delirium of elderly patients,which provides the evidence for making the intervening clinic measures. Methods Such databases as Wanfang,CNKI and VIP were electronically searched to collect research literatures from the database building to December 2013 about the risk factors of postoperative delirium of elderly patients,which were screened according to the inclusion and elimination criteria. Then,meta-analysis was performed by Rev Man 5. 2 Software to analyze the prevalence of high risk factors for postoperative delirium of elderly patients. Results 16 literatures were involved including 8 case- controls（ involving 353 cases and 2 008 controls） and 8 case-series. The OR（ 95% CI） values of risk factors of postoperative delirium were as follows： Hypoxemia 2. 58（ 1. 59,4. 18）,with lung infection 4. 76（ 1. 36,16. 67）, with hypertension 2. 16（ 1. 20,3. 89）, with coronary heart disease 1. 50（ 0. 82,2. 73）,postoperative pain 3. 18（ 1. 63,6. 20）,general anesthesia 3. 64（ 0. 94,14. 11）,operation time 32. 30（- 37. 67,102. 27） and older ages（ ≥70） 0. 99（- 0. 46,2. 45）. The results of meta- analysis showed that hypoxemia,lung infection,hypertension and postoperative pain were the high risk factors of postoperative delirium,with significant difference（ P 0. 05）.The results of 404 cumulative cases showed that the incidences of hypoxemia and complication with hypertension were 62. 6%（ 253 cases） and 55. 9%（ 226 cases）,which were relatively higher than others. Conclusion Preoperative hypertension and lung infection and postoperative hypoxemia and pain are the high risk factors of delirium.

关 键 词：老年人 谵妄 危险因素 系统评价 META分析 

分 类 号：R473.74[医药卫生—护理学]