老年全髋关节置换术后谵妄与围术期炎症因子水平的相关性研究  

Correlation of Perioperative Levels of Inflammatory Factors with Postoperative Delirium in Elderly Total Hip Arthroplasty

作　　者：王贵方[1] 尚平福 王涛[1] 

机构地区：[1]邯郸钢铁集团有限责任公司职工医院骨科,河北邯郸056001

出　　处：《实用骨科杂志》2017年第4期306-308,共3页Journal of Practical Orthopaedics

摘　　要：目的探讨老年全髋关节置换术后谵妄的发生与围术期炎症因子水平的相关性。方法纳入年龄大于等于65岁的全髋关节置换术患者182例为研究对象,于术后参考意识混乱评估法诊断谵妄,并将患者划分为谵妄组(58例)和对照组(124例),统计患者术前、术后1h、术后6h血清C反应蛋白(C-Reactive protein,CRP)、白细胞介素(interleukin,IL)-1β、IL-6、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)水平,分析上述指标与术后谵妄的相关性。结果组内对比显示,谵妄组术后1h、6h时IL-1β及IL-6水平明显高于术前,术后6h时CRP水平明显高于术前,对照组术后1h、6h时IL-6水平明显高于术前,术后6h时CRP水平明显高于术前,上述差异均具有统计学意义(P<0.05);组间对比显示,术后1h谵妄组IL-1β水平明显高于对照组,术后6h谵妄组IL-6水平明显高于对照组,上述差异均具有统计学意义(P<0.05)。回归分析显示术后1h时IL-1β、术后6h时IL-6水平是术后谵妄的独立影响因素(P<0.05)。结论老年全髋关节置换术后谵妄发生率较高,检测早期IL-1β及IL-6水平可能有助于预测其风险。Objective To investigate the correlation between the occurrence of postoperative delirium and the level of inflammatory factors in the elderly patients after total hip arthroplasty.Methods 182 patients aged more than years with total hip arthroplasty were enrolled in this study and divided into delirium group （58 cases） and control group （124 cases） by reference to disturbance of consciousness. The levels of serum C-reactive protein （CRP）, interleukin （IL）-1β,IL-6 and tumor necrosis factor （TNF）-α were measured before operation and lh and 6h after operation. The correlation between the above indexes and the postoperative delirium was analyzed.Results Compared with before op- eration,the levels of IL-1β and IL-6 at 1h and 6h after operation and CRP at 6h after operation in the delirium group, and the levels of IL-6 at lh and 6h after operation and CRP at 6h after operation in the control group were significantly increased（P〈0.05）.Compared with the control group,the level of IL-1β at lh after operation and IL-6 at 6h after oper ation in the delirium group was significantly higher（P〈0.05）.Regression analysis showed that the level of IL-1β at 1 hour after operation and IL-6 at 6h after operation was an independent risk factor of postoperative delirium（P〈0.05）. Conclusion The incidence of delirium in elderly patients with total hip arthroplasty is high,and early detection of IL-1β and IL-6 levels can help to predict the risk of postoperative delirium.

关 键 词：老年患者 全髋关节置换术 术后并发症 谵妄 炎症因子 

分 类 号：R687.42[医药卫生—骨科学]