骨科手术老年患者术后高活动型谵妄发生的危险因素  

Risk factors for postoperative hyperactive-type delirium in elderly patients undergoing orthopedic surgery

作　　者：朱纯纯[1] 南克 项芳芳 陈丽琼[1] 黄葱葱[1] 张旭彤[1] 马剑锋[1] 李军[1] Zhu Chunchun;Nan Ke;Xiang Fang.fang;Cheng Liqiong;Huang Congcong;Zhang Xutong;Ma Jianfeng;Li Jun(Department of Anethesiology and Perioperative Medicine, Second Affiliated Hospital and Yuying Children＇s Hospital of Wenzhou Medical University, Wenzhou 325027, Chin)

机构地区：[1]温州医科大学附属第二医院育英儿童医院麻醉与围术期医学科,325027

出　　处：《中华麻醉学杂志》2018年第2期185-187,共3页Chinese Journal of Anesthesiology

摘　　要：目的 筛选骨科手术老年患者术后高活动型谵妄发生的危险因素.方法 选择2008年1月至2012年12月行骨科手术的老年患者7 171例,性别不限,年龄≥65岁,ASA分级为Ⅰ-Ⅳ级.收集患者性别、年龄;术前电解质、血糖、血红蛋白、白蛋白、是否存在老年痴呆、是否使用苯二氮类药物;手术类型、麻醉方式、手术时间、术中是否使用抗胆碱能药物和苯二氮[艹卓]类药物、低血压（较基础血压下降20％以上）;术后电解质、血红蛋白、白蛋白和低血压.根据术后7d内是否发生高活动型谵妄,分为术后高活动型谵妄组（PHTD组）和非术后高活动型谵妄组（非PHTD组）.将组间比较差异有统计学意义的因素进行多因素logistic回归分析,筛选骨科手术老年患者术后高活动型谵妄发生的危险因素.结果 有99例患者发生了术后高活动型谵妄,发生率为1.38％.logistic回归分析的结果显示：年龄≥80岁、髋部手术和术前贫血是骨科手术老年患者术后高活动型谵妄发生的独立危险因素（P＜0.05）.结论 年龄≥80岁、髋部手术、术前贫血是骨科手术老年患者术后高活动型谵妄发生的独立危险因素.Objective To determine the risk factors for postoperative hyperactive-type delirium （PHTD） in elderly patients undergoing orthopedic surgery.Methods A total of 7 171 elderly patients of both sexes,aged more than or equal to 65 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅳ,who underwent orthopedic surgery from January 2008 to December 2012 in Second Affiliated Hospital of Wenzhou Medical University,were retrospectively analyzed.Data such as gender,age,preoperative electrolytes,blood glucose,hemoglobin,albumin,senile dementia and use of benzodiazepines,type of operation,anesthesia methods,operation time,intraoperative use of anticholinergic agents and benzodiazepines and hypotension （decrease more than 20% of the baseline）,and postoperative electrolyte,hemoglobin,albumin and hypotension were collected.The patients were divided into postoperative PHTD group （group PHTD） and postoperative non-PHTD group （group non-PHTD） according to whether PHTD developed within 7 days after operation.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression to stratify the risk factors for postoperative PHTD.Results Ninety-nine patients developed PHTD,and the incidence was 1.38%.The results of logistic regression analysis showed that age more than or equal to 80 yr,hip surgery and preoperative anemia were independent risk factors for postoperative PHTD （P〈0.05）.Conclusion Age more than or equal to 80 yr,hip surgery and preoperative anemia are independent risk factors for postoperative PHTD in elderly patients undergoing orthopedic surgery.

关 键 词：谵妄 老年人 危险因素 骨科手术 

分 类 号：R614[医药卫生—麻醉学]