老年患者髋部骨折术后谵妄的危险因素分析  

Risk factors of postoperative delirium in elderly patients with hip fracture

作　　者：贾佩玉 郭勇[1] 王学敏[1] 江伟[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《上海医学》2016年第8期477-481,共5页Shanghai Medical Journal

摘　　要：目的探讨老年患者髋部骨折术后谵妄发生的危险因素。方法选取286例髋部骨折后行单侧全髋关节置换术的老年（年龄≥60岁）患者，发生术后谵妄60例（谵妄组），未发生术后谵妄226例（对照组）。收集患者的病史资料、实验室检查结果、手术和麻醉相关资料等，对可能的危险因素进行组间比较后，对差异有统计学意义的指标进行Logistic回归分析。结果谵妄组的年龄显著大于对照组（P〈0．01），有脑梗死和心房颤动的患者构成均显著高于对照组（P值分别〈0．05、0．01），白细胞计数、中性粒细胞比例、总胆红素水平、直接胆红素水平、血糖水平、CRP水平均显著高于对照组（P值均〈0．01），红细胞计数、血小板计数、血红蛋白水平、红细胞比容、白蛋白水平、总蛋白水平均显著低于对照组（P值均〈0．01），凝血酶原时间、活化部分凝血活酶时间均显著长于对照组（P值分别〈0．01、0．05），术中出血量和红细胞输入量均显著多于对照组（P值分别〈0．05、0．01）。两组间性别构成、BMI、入院到手术时间，高血压、糖尿病和帕金森病的患者构成，钾离子、钠离子、氯离子、钙离子、磷离子、镁离子、丙氨酸转氨酶、天冬氨酸转氨酶、血尿素氮、肌酐、谷氨酰转肽酶、纤维蛋白原、胱抑素C水平，以及血尿素氮／肌酐、白蛋白／球蛋白、红细胞沉降率、麻醉时间、手术时间、血浆输入量、自体血输入量的差异均无统计学意义（P值均〉O．05）。Logistic回归分析结果显示，年龄（OR=1.123，95％CI为1．055～1．194）、总胆红素水平（OR=1．078，95％CI为1．023～1．137）、血糖水平（OR=1．209，95％CI为1．029～1．420）、CRP水平（OR=1．030，95oACI为1.007～1．053）、红细胞输入量（OR=1．002，95％CI为1．001～1．004）为老年患者髋部骨折术后发生谵妄的独立危�Objective To explore the risk factors of postoperative delirium in elderly patients with hip fracture. Methods A total of 286 elderly patients （≥60 years old） with hip fracture treated by unilateral total hip arthroplasty （THA） were enrolled in this study. Postoperative delirium occurred in 60 patients （delirium group）, and another 226 patient without delirium were. assigned to control group. Clinical data, laboratory examination results, surgical and anesthetic information were collected. Possible risk factors were compared between groups and those parameters with statistical significance were analyzed by logistic regression analysis. Results Average age, patient ratio of cerebral infarction history, patient ratio of atrial fibrillation history, white blood cell count, the percentage of neutrophils, total bilirubin, direct bilirubin, blood glucose, and C-reactive protein （CRP） in delirium group were significantly higher than those in control group （P〈0.01, 0.05）. Red blood cell count, platelet, hemoglobin, hematocrit, albumin, total protein, intraoperative blood loss, and red blood cell transfusion in delirium group were significantly lower than those in control group （P〈0.01, 0.05）. Prothrombin time and activated partial thromboplastin time in delirium group were significantly longer than those in control group （P〈0.05, 0.01）. There were no significant differences in terms of gender composition, BMI, the duration between admission and surgery, patient ratio of hypertension, diabetes, or Parkinson＇s disease, serum kalium, sodium, chloridion,calcium, phosphonium, magnesium, alanine aminotransferase, aspartate, aminotransferase, urea nitrogen （BUN）, creatinine （Or）, BUN/Cr, albumin/globulin, glutamyltranspeptidase, fibrinogen, cystatin C, erthrocyte sedimentation rate, anesthetic time, operation time, blood transfusion, or autologous transfusion between groups （all P〉0.05）. Logistic regression analysis showed that age （OR = 1. 123, 95% CI： 1. 055- 1. 194）,

关 键 词：术后谵妄 危险因素 老年患者 髋部骨折 

分 类 号：R687.3[医药卫生—骨科学]