股骨粗隆间骨折术后谵妄发生的因素分析及预后对并发症的影响  

Factors analysis and prognostic impact of delirium after intertrochanteric fracture surgery

作　　者：李玲[1] 阮传江[1] 张璇 周瑞娟 李琳 Li Ling;Ruan Chuanjiang;Zhang Xuan(Department of Orthopaedics,Taihe County People′s Hospital,Fuyang 236600,China)

机构地区：[1]太和县人民医院、皖南医学院附属太和医院骨科,阜阳236600 [2]太和县人民医院、皖南医学院附属太和医院手术室,阜阳236600

出　　处：《中华保健医学杂志》2024年第3期360-363,共4页Chinese Journal of Health Care and Medicine

基　　金：阜阳市自筹经费科技计划项目(FK202081069)。

摘　　要：目的 探究股骨粗隆间骨折术后谵妄发生的因素分析及预后影响。方法 回顾性选取2021年7月~2022年12月在太和县人民医院接受手术治疗的41例股骨粗隆间骨折术后出现谵妄的患者为谵妄组,同期选择术后未出现谵妄的患者41例为非谵妄组。搜集两组患者的一般资料,采用多因素logistic回归分析法分析股骨粗隆间骨折术后谵妄发生的因素分析及预后影响。结果 谵妄组汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分、血氧分压(PaO2)、受伤至手术时间、年龄、手术时间以及合并基础疾病与非谵妄组比较,差异有统计学意义(P<0.05)。对术后发生谵妄进行单因素分析发现,两组患者术前白蛋白、镇痛泵、术中出血量、发生骨折至接受手术的天数、术中低氧血症以及是否使用咪达唑仑,差异均有统计学意义(P<0.05)。多因素分析显示,年龄、术前血清白蛋白水平、术中低氧血症等均与术后谵妄存在显著关联,是其独立危险因子(P<0.05)。两组患者心脏不良事件和肺部感染方面,差异有统计学意义(P<0.05)。而在脑血管事件、消化道出血和其他并发症方面,两组之间差异无统计学意义(P> 0.05)。结论 年龄、麻醉方式、术前白蛋白、术中低氧血症、术后镇痛(使用咪达唑仑)是股骨粗隆间骨折术后谵妄发生的重要影响因素。对于股骨粗隆间骨折患者,在围手术期中,需要严密观察生命体征变化,尤其是高危患者,在加强术后谵妄风险评估的同时,还需要加强其健康教育积极配合实施预防谵妄的措施,防止术后谵妄的发生,提高患者预后质量。Objective To explore the factors associated with delirium occurrence following surgical treatment for intertrochanteric fractures of the femur and its impact on prognosis.Methods A retrospective analysis was conducted on 41 patients who developed postoperative delirium after surgical treatment for femoral intertrochanteric fractures at Taihe County People′s Hospital from July 2021 to December 2022.Additionally,41 patients without postoperative delirium during the same period were selected.According to whether postoperative delirium occurred,they were divided into delirium group and non delirium group.General and clinical data were collected for both groups,and multivariate logistic regression analysis to analyze the factors and prognostic effects of postoperative delirium in patients with intertrochanteric fractures of the femur.Results Comparing the general data of the two groups,it was found that there were statistically significant differences in HAMD,HAMA score,PaO 2,injury to surgery time,age,surgery time,and comorbidities between the delirium group and the non delirium group(P<0.05).Univariate analysis of postoperative delirium found that there were statistically significant differences between the two groups in preoperative albumin,analgesic pump,intraoperative bleeding,days from fracture to surgery,intraoperative hypoxemia,and whether midazolam was used(P<0.05).Multivariate analysis showed that age,preoperative serum albumin levels,and intraoperative hypoxemia were significantly associated with postoperative delirium and were independent risk factors(P<0.05).There was a significant difference between the two groups in terms of adverse cardiac events and pulmonary infections(P<0.05),respectively.However,there was no significant difference between the two groups in terms of cerebrovascular events,gastrointestinal bleeding,and other complications(P>0.05).Conclusion Age,anesthesia method,preoperative albumin levels,intraoperative hypoxemia,and postoperative analgesia(midazolam use)are important factors infl

关 键 词：股骨 骨折 术后 谵妄发生 因素 

分 类 号：R68[医药卫生—骨科学]