修正衰弱指数与人工关节置换术后老年病人谵妄发生的关系  

Relationship between modified Frailty Index and development of delirium after artificial joint replacement in elderly patients

作　　者：崔凡[1] 赵伟[2] 李春晶[1] 穆东亮[1] Cui Fan;Zhao Wei;Li Chunjing;Mu Dongliang(Department of Anesthesiology and Surgical Intensive Care,Peking University First Hospital,Beijing 100034,China;Department of Anesthesiology,The Forth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]北京大学第一医院麻醉与重症医学科,100034 [2]河北医科大学第四医院麻醉科,石家庄050011

出　　处：《中华麻醉学杂志》2019年第10期1158-1161,共4页Chinese Journal of Anesthesiology

基　　金：国家重点研发计划(2018YFC2001800);河北省医学科学研究重点课题(20190709)。

摘　　要：目的评价修正衰弱指数(mFI)与人工关节置换术后老年病人谵妄发生的关系。方法本研究以接受择期人工髋关节或膝关节置换术的老年病人(年龄≥60岁)为研究对象。采用mFI量表评估病人术前衰弱状态。所有病人均在腰麻-硬膜外麻醉下手术治疗。主要观察指标为术后5 d内谵妄发生率,采用CAM或CAM-ICU进行评估。按照病人是否发生谵妄,将病人分为谵妄组和非谵妄组。结果共纳入620例病人,mFI为0.09(0.18)分,术后5 d内谵妄发生率为8.5%。多因素logistic回归分析显示:年龄增加(OR值1.068,95%置信区间1.018~1.120,P=0.007)、术后吗啡用量大(OR值1.089,95%置信区间1.051~1.128,P<0.01)和mFI升高(OR值2.465,95%置信区间1.636~3.714,P<0.01)是术后谵妄发生的独立危险因素。结论mFI升高是老年病人人工关节置换术后谵妄发生的独立危险因素。Objective To evaluate the relationship between modified Frailty Index(mFI)and development of delirium after artificial joint replacement in elderly patients.Methods Elderly patients(aged≥60 yr)who scheduled for elective hip or knee replacement,were enrolled.Preoperative frailty was assessed using the mFI scale.All the patients received surgery under combined spinal-epidural anesthesia.Primary outcome was the incidence of delirium within 5 days after operation,and delirium was assessed by Confusion Assessment Method or Confusion Assessment Method-Intensive Care Unit.The patients were divided into delirium group and non-delirium group according to whether delirium occurred or not.Results A total of 620 patients were included in the study,the mFI was 0.09(0.18),and the incidence of delirium within 5 days after surgery was 8.5%.The results of multivariate logistic regression analyses showed that increase in age(OR 1.068,95%CI 1.018-1.120,P=0.007),higher postoperative consumption of morphine(OR 1.089,95%CI 1.051-1.128,P<0.01)and higher mFI(OR 2.465,95%CI 1.636-3.714,P<0.01)were the independent risk factors for postoperative delirium.Conclusion Higher mFI is the independent risk factor for delirium after artificial joint replacement in elderly patients.

关 键 词：关节成形术 置换 老年人 谵妄 修正衰弱指数 

分 类 号：R687.4[医药卫生—骨科学]