老年患者行股骨转子间骨折内固定术后并发谵妄的相关因素分析  

Correlation factors analysis on postoperative delirium of elderly patients with intertrochanteric fracture fixation

作　　者：廖向荣[1] 林剑雄[1] 蔡拉加[1] 刘潮坚[1] 石昭宏[1] 

机构地区：[1]潮州市中心医院骨科,广东潮州521000

出　　处：《局解手术学杂志》2017年第2期152-155,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨老年患者行股骨转子间骨折内固定术后并发谵妄的相关危险因素。方法对2012年1月至2014年7月在我院行股骨转子间骨折内固定术的160例患者的临床资料进行回顾性分析,对患者的年龄、性别、术前合并症、术前认知功能状态、骨折部位、手术方式、手术时间、麻醉方式、入院至手术时间以及术中出血量等危险因素进行归纳总结。结果术后老年股骨转子间骨折术后谵妄的发生率为28.15%。单因素分析显示,谵妄的发生与患者术前认知功能损伤、术前准备时间、血钠、芬太尼、房颤、麻醉方式、手术时间以及围手术期失血量等具有相关性(P<0.05)。而多因素Logistic回归分析结果显示,患者术后谵妄发生的独立危险因素主要为术前认知功能缺陷、手术时间大于2 h、术前准备时间大于4 d。结论术后谵妄的发生与麻醉方式、认知功能缺陷、术前准备时间以及围手术期失血量具有相关性,选用对机体全身状态影响比较小的麻醉方式,缩短手术准备时间能够在一定程度上减少术后谵妄的发生,有利于改善预后。Objective To investigate the risk factors of delirium in elderly patients with intertrochanteric fracture after internal fixation. Methods The data of 160 patients with intertrochanteric fractures who received internal fixation in our hospital from January 2012 to July 2014 were analyzed retrospectively. The risk factors such as age, sex, preoperative complications, preoperative cognitive function, fracture loca- tion, operation mode, operation time, anesthesia method, hospital-to-operation time and intraoperative blood loss were summarized. Results The incidence of postoperative delirium was 28. 15% in postoperative elderly patients with intertrochanteric fractures. Univariate analysis showed that delirium had correlated with preoperative cognitive impairment, preoperative preparation time, serum sodium, fentanyl, atrial fibril- lation, anesthesia method, operation time and perioperative blood loss （ P 〈 0.05 ）. The multivariate Logistic regression analysis showed that the independent risk factors of postoperative delirium were preoperative cognitive dysfunction, operative time more than 2 hours and preoperative preparation time more than 4 days. Conclusion The occurrence of postoperative delirium was associated with anesthesia method, cognitive deficits, preoperative preparation time and perioperative blood loss. The anesthesia method which had less effect on the whole body condition and less time of operation preparation can decrease the occurrence of postoperative delirium in a certain extent,which is conducive to impro- ving the prognosis.

关 键 词：股骨转子间骨折 谵妄 内固定术 危险因素 老年患者 

分 类 号：R683.4[医药卫生—骨科学]