老年病人全麻下髋关节置换术后谵妄危险因素分析  

Risk factors of postoperative delirium in elderly patients undergoing hip arthroplasty under general anesthesia

作　　者：李楠 纪玮玮 刘伟 陈雪 LI Nan;JI Wei-wei;LIU Wei;CHEN Xue(Department of Anesthesiology,Suqian Hospital of Nanjing Drum-Tower Hospital Group,Suqian 223800,China)

机构地区：[1]南京鼓楼医院集团宿迁医院麻醉科,江苏省宿迁市223800

出　　处：《实用老年医学》2022年第8期838-841,共4页Practical Geriatrics

摘　　要：目的明确全麻下髋关节置换老年病人术后谵妄的发生情况及危险因素。方法选取2018年1月至2021年6月于我院行全麻下髋关节置换术的老年病人,对病人的术后谵妄发生情况及危险因素进行单因素及多因素Logistic回归分析。结果196例老年病人中,66例(33.67%)发生术后谵妄。谵妄组和无谵妄组年龄、美国麻醉医师协会麻醉分级>Ⅱ级、术中出血量>300 mL、手术时间>120 min、术前合并低蛋白血症、术前焦虑、术后VAS评分>3分、P维度评分、N维度评分以及E维度评分等方面差异均有统计学意义(P<0.05)。多因素Logistic回归分析表明:年龄>75岁、术中出血量>300 mL、术前合并低蛋白血症、术前焦虑、术后VAS评分>3分、N维度评分≥56.8分以及E维度评分≥56.8分是全麻下髋关节置换老年病人发生术后谵妄的危险因素。结论全麻下髋关节置换老年病人术后谵妄发生率较高,影响病人发生术后谵妄的因素较多,性格外向与神经质是髋关节置换老年病人发生术后谵妄的危险因素,临床中应针对相关病人加强心理疏导及干预。Objective To explore the incidence and risk factors of postoperative delirium in the elderly patients undergoing hip arthroplasty under general anesthesia.Methods A total of 196 elderly patients who underwent hip arthroplasty in our hospital under general anesthesia from January 2018 to June 2021 were enrolled in this study.The incidence and risk factors of postoperative delirium were analyzed by univariate and multivariate Logistic regression.Results Among 196 elderly patients undergoing hip arthroplasty under general anesthesia,66 presented with postoperative delirium,with an incidence rate of 33.67%.There were significant differences in age,ASA grade>gradeⅡ,intraoperative bleeding>300 mL,operation time>120 min,preoperative hypoproteinemia,preoperative anxiety,postoperative VAS score>3,P dimension score,N dimension score and E dimension score between delirium group and non-delirium group(P<0.05).Multivariate Logistic regression analysis showed that age>75 years old,intraoperative bleeding>300 mL,preoperative hypoproteinemia,preoperative anxiety,postoperative VAS score>3,N dimension score≥56.8 and E dimension score≥56.8 were the risk factors of postoperative delirium in the elderly patients undergoing hip arthroplasty under general anesthesia.Conclusions The incidence of postoperative delirium in the elderly patients undergoing hip arthroplasty under general anesthesia is high.Extroversion and neuroticism are the risk factors of postoperative delirium in the patients undergoing hip arthroplasty.We should strengthen psychological counseling and intervention for relevant patients.

关 键 词：人格因素 全身麻醉 老年人 髋关节置换 术后谵妄 危险因素 

分 类 号：R749.69[医药卫生—神经病学与精神病学]