营养不良与老年髋关节置换术后谵妄的关系  

Association between malnutrition and postoperative delirium after hip arthroplasty in elderly patients

作　　者：李涛[1] 徐小东[2] 张蒙 刘芳[4] 赵立 段军[1] 孙思伟 Tao Li;Xiao-dong Xu;Meng Zhang;Fang Liu;Li Zhao;Jun Duan;Si-wei Sun(Surgical Intensive Care Unit,China-Japan Friendship Hospital,Beijing 100029,China;Department of Orthopaedic,China-Japan Friendship Hospital,Beijing 100029,China;Department of Psychology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Nutritional,China-Japan Friendship Hospital,Beijing 100029,China;Department of Geriatric,China-Japan Friendship Hospital,Beijing 100029,China;President's Office,Peking University Sixth Hopital,Beijing 100083,China)

机构地区：[1]中日友好医院外科重症医学科,北京100029 [2]中日友好医院关节骨科,北京100029 [3]中日友好医院心理科,北京100029 [4]中日友好医院营养科,北京100029 [5]中日友好医院老年科,北京100029 [6]北京大学第六医院党委院长办公室,北京100083

出　　处：《中国现代医学杂志》2019年第23期48-51,共4页China Journal of Modern Medicine

基　　金：国家自然科学基金（No:81774265）

摘　　要：目的探讨营养状况与老年髋关节置换术后谵妄(POD)的关系。方法前瞻性研究2014年6月-2018年5月在中日友好医院行髋关节置换的大于65岁患者。术前应用微型营养评估简表(MNA-SF)评估患者营养状态。依据意识模糊评估法诊断谵妄。观察记录患者是否发生POD直至出院。使用多变量回归分析基于MNA-SF的3级分层,以评估营养状态在POD中的作用。结果纳入的276例患者中,52例营养不良,123例有营养不良风险,101例营养良好。POD发生率分别是48.08%、36.59%和12.87%。随着营养状态变差,POD发生率越高(P<0.05)。Logistic回归分析显示,有营养不良风险和营养不良更有可能发生POD[O^R=2.42(95%CI:1.29,4.53);O^R=2.98(95%CI:1.43,6.19)]。结论营养不良是老年髋关节置换POD的独立预测因素。Objective To explore the association between malnutrition and postoperative delirium after hip arthroplasty in elderly patients. Methods The prospective study was carried out in our hospital between June 2014 and May 2018, and all patients aged older than 65 years at the time of hip arthroplasty were included. A Mini Nutritional Assessment Short Form(MNA-SF) was used to assess the nutritional status of patients before surgery, and disorders of consciousness were assessed with Confusion Assessment Method(CAM). Descriptive statistics were used to summarize the data and factors associated with POD, and the factors were identified by multivariable regression analysis. Results A total of 276 patients were involved in this study. 52 patients were classified as undernourished individuals, 123 patients were at risk of malnutrition, and 101 individuals were defined as well nourished. The incidence of POD was 48.08%, 36.59% and 12.87% among the three groups, respectively. Therefore, as the nutritional status deteriorates, the incidence of POD was higher(P < 0.05). After univariate regression analysis, further multivariate regression analysis showed that malnutrition risk and malnutrition were factors associated with POD [O^R = 2.42,(95% CI: 1.29, 4.53);O^R = 2.98,(95% CI: 1.43, 6.19)]. 【Conclusions】 During the perioperative period of hip arthroplasty surgery, malnutrition risk state and malnutrition status, which were assessed by MNA-SF, can be independent predictors of POD in elderly patients.

关 键 词：营养不良 老年 髋关节置换 谵妄 

分 类 号：R591[医药卫生—内科学]