老年髋关节置换术后患者发生谵妄的危险因素  

Risk factors for postoperative delirium in elderly patients after total hip arthroplasty

作　　者：高志祥 姜义山[1] 龙能吉 肖聪[1] Gao Zhixiang;Jiang Yishan;Long Nengji;Xiao Cong(Second Department of Orthopedics,the Third Hospital of Mianyang,Mianyang 621000,Sichuan Province,China)

机构地区：[1]绵阳市第三人民医院骨二科

出　　处：《中国组织工程研究》2019年第32期5097-5102,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:老年全髋关节置换患者术后易发生谵妄,因此明确术后谵妄危险因素非常必要。目的:探讨老年全髋关节置换患者术后谵妄危险因素。方法:回顾性分析绵阳市第三人民医院2016年5月至2018年12月行全髋关节置换治疗的60岁以上患者资料,收集患者围术期临床资料,根据术后是否发生谵妄分为非谵妄组和谵妄组,分析术后谵妄的危险因素。结果与结论:(1)患者365例在髋关节置换中有96例(发生率约为26%)术后出现谵妄;(2)单因素分析显示:两组患者在年龄、性别、合并冠心病、合并慢性阻塞性疾病、疾病类型、认知障碍、睡眠障碍、焦虑、美国麻醉师协会评分、营养障碍、衰弱GFI指数、术前及术后白细胞计数、术后红细胞比容、术后血红蛋白水平、术后C-反应蛋白及术中失血量方面差异有显著性意义(P<0.05);(3)多因素Logistic回归分析发现:年龄(OR=1.19,95%CI:1.12-1.25)、美国麻醉师协会评分评分(OR=8.03,95%CI:4.54-14.21)、GFI评分(OR=2.14,95%CI:1.78-2.57)、术后C-反应蛋白水平(OR=1.07,95%CI:1.05-1.09)、合并慢性阻塞性疾病(OR=0.43,95%CI:0.26-0.69)、股骨颈骨折(OR=3.67,95%CI:2.23-6.13)行全髋关节置换是老年行全髋关节置换后发生谵妄的高危因素(P<0.05);(4)ROC曲线分析显示:年龄>71岁,美国麻醉师协会评分评分>2分,衰弱GFI评分≥5分,术后C-反应蛋白>47 mmol/L,此时4个变量灵敏性和特异性较好,对预测术后谵妄具有一定临床价值。BACKGROUND:Delirium is easy to occur in elderly patients after total hip arthroplasty,so it is necessary to identify the risk factors of postoperative delirium.OBJECTIVE:To investigate the risk factors of postoperative delirium in elderly patients after total hip arthroplasty.METHODS:Data of patients over 60 years old who underwent total hip arthroplasty in the Third Hospital of Mianyang from May 2016 to December 2018 were retrospectively analyzed.Perioperative data were collected.According to the presence and absence of delirium after operation,the patients were divided into non-delirium group and delirium group.The risk factors of postoperative delirium were analyzed.RESULTS AND CONCLUSION:(1)The incidence of delirium was 26%(96 cases)after total hip arthroplasty in 365 patients.(2)Univariate analysis showed that age,sex,coronary heart disease,chronic obstructive pulmonary disease,type of disease,cognitive impairment,sleep disorder,anxiety,American Society of Anesthesiologists score,nutritional impairment,weak GFI index,leukocyte count before and after operation,erythrocyte specific volume after operation,hemoglobin level after operation,C-reactive protein after operation and intraoperative blood loss were significantly different between the two groups(P<0.05).(3)Multivariate Logistic regression analysis showed that age(OR=1.19,95%CI:1.12-1.25),American Society of Anesthesiologists score(OR=8.03,95%CI:4.54-14.21),GFI score(OR=2.14,95%CI:1.78-2.57),postoperative C-reactive protein(OR=1.07,95%CI:1.05-1.09),combined with chronic obstructive pulmonary disease(OR=0.43,95%CI:0.26-0.69),total hip arthroplasty for femoral neck fracture(OR=3.67,95%CI:2.23-6.13)were high risk factors for postoperative delirium after total hip arthroplasty in the elderly(P<0.05).(4)ROC curve analysis displayed that when age>71 years old,American Society of Anesthesiologists score>2,weakness GFI score≥5,and C-reactive protein>47 mmol/L,all of them had good specificity and sensitivity,which has certain clinical value in predicting postope

关 键 词：全髋关节置换 术后谵妄 衰弱 股骨头缺血性坏死 焦虑 抑郁 美国麻醉师协会评分评分 股骨颈骨折 血红蛋白 红细胞比容 

分 类 号：R459.9[医药卫生—治疗学] R604[医药卫生—临床医学]