高龄髋部骨折患者术后谵妄危险因素调查  

Risk factors for postoperative delirium in elderly patients undergoing surgery for hip fractures

作　　者：喻任[1] 陆纯德[1] 程艳[1] 王喆人[1] 陈媛媛[1] 介勇[2] 

机构地区：[1]上海建工医院骨科,上海200083 [2]上海市虹口区精神卫生中心

出　　处：《中国骨与关节损伤杂志》2016年第4期341-344,共4页Chinese Journal of Bone and Joint Injury

基　　金：上海卫生局科研课题计划(20134402)

摘　　要：目的明确年龄≥75岁高龄髋部骨折术后谵妄的发病率,筛选导致术后谵妄的危险因素。方法自2012-06—2015-06诊治年龄≥75岁的髋部骨折435例,统计术后谵妄发生率,并根据术后3 d内是否发生谵妄分为谵妄组和非谵妄组。可疑危险因素进行组间比较后,将差异有统计学意义的因素进行Logistic回归分析,筛选发生术后谵妄的危险因素。结果 102例发生术后谵妄,发生率23.45%。谵妄组与非谵妄组间年龄、术前白蛋白、术后血红蛋白、术后红细胞压积、简易精神状态评价量表评分(MMSE评分)、术前老年痴呆病史、视力障碍、听力障碍、留置导尿、居住状态的差异有统计学意义(P<0.05)。Logistic回归分析结果显示视力障碍、留置导尿、低MMSE评分、低白蛋白是发生术后谵妄的独立危险因素(P<0.05)。结论髋部骨折手术是术后谵妄发生的重要原因;年龄不是高龄髋部骨折患者术后谵妄的独立危险因素;术前认知功能与感觉功能障碍及低营养状态是高龄髋部骨折患者出现术后谵妄的主要危险因素。Objective To investigate the risk factors for post-operative delirium in elderly patients undergoing surgery for hip fractures. Methods From June 2012 to June 2015, 435 patients aged 75 yr or older undergoing elective surgery of hip fracture were included in this study. The diagnosis of delirium was based on Confusion Assessment Method（CAM）. Multivariate logistic regression was used to analyze the risk factors for postoperative delirium. Results Postoperative delirium developed in 102 patients during the first three post-operative days. The incidence of postoperative delirium was 23.45%. The logistic stepwise regression analysis indicated that the risk factors for delirium included visual impairment, bladder catheter, low serum albumin level and low MMSE score. Conclusion Age is not a significant predictive factor for the postoperative delirium after hip fracture surgery in elderly patients. Premorbid cognition or visual impairment is the most significant predisposing factor for the development of delirium.

关 键 词：谵妄 髋部骨折 危险因素 老年 

分 类 号：R687.3[医药卫生—骨科学]