髂筋膜阻滞老年髋部骨折患者术后谵妄的影响因素研究  

A study on the influencing factors of postoperative delirium in elderly patients with hip fractures treated with iliac fascia block

作　　者：张跃东 黄福泉 王玲[1] 汪东学 魏敏[1] ZHANG Yuedong;HUANG Fuquan;WANG Ling;WANG Dongxue;WEI Min(Anesthesiology Department of Anqing First People’s Hospital Affiliated to Anhui Medical University,Anqing,Anhui,China,246004)

机构地区：[1]安徽医科大学附属安庆第一人民医院麻醉科,安徽安庆246004

出　　处：《分子诊断与治疗杂志》2024年第7期1377-1380,1385,共5页Journal of Molecular Diagnostics and Therapy

基　　金：安庆市自筹经费科技计划项目(2020Z5009)。

摘　　要：目的 探讨髂筋膜阻滞老年髋部骨折患者术后谵妄的影响因素及中性粒细胞/淋巴细胞比值(NLR)、胰岛素(INS)、磷酸化tau蛋白(p-tua)对其诊断价值。方法 分析2021年1月至2022年9月安徽医科大学附属安庆第一人民医院收治的108例髂筋膜阻滞老年髋部骨折患者的临床资料,根据其是否发生术后谵妄分为术后谵妄组(42例)和术后非谵妄组(66例)。分析髂筋膜阻滞老年髋部骨折患者术后谵妄的单因素,利用多因素Logistic回归分析髂筋膜阻滞老年髋部骨折患者术后谵妄的危险因素,绘制受试者工作特征曲线(ROC)分析全血NLR、INS、p-tua联合检测对髂筋膜阻滞老年髋部骨折患者术后谵妄的预测价值。结果 术后谵妄组与术后非谵妄组年龄、术前有无颈动脉狭窄、手术时间及全血NLR、INS、p-tua水平比较,差异有统计学意义(χ^(2)=8.911、13.487,t=6.030、6.952、6.398、5.946,P<0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、术前有颈动脉狭窄、手术时间≥2.5 h及全血NLR、INS、p-tua水平偏高是髂筋膜阻滞老年髋部骨折患者术后谵妄的独立危险因素(OR=2.489、4.125、2.040、3.438、2.942、2.962,P<0.05)。ROC曲线分析结果显示,全血NLR、INS、p-tua联合诊断髂筋膜阻滞老年髋部骨折患者术后谵妄的曲线下面积(AUC)值为0.905,高于全血NLR、INS、p-tua单独检测(0.762、0.718、0.777,P<0.05)。结论 髂筋膜阻滞老年髋部骨折患者术后谵妄与年龄≥60岁、术前有颈动脉狭窄、手术时间≥2.5 h及全血NLR、INS、p-tua水平偏高有关。Objective To investigate the the influencing factors of postoperative delirium in el-derly patients with hip fractures treated with iliac fascia block and the diagnostic value of neutrophil/lympho-cyte ratio(NLR),insulin(INS),phosphorylated tau protein(p-tua).Methods The clinical data of 108 el-derly patients with hip fractures treated with iliac fascia block at Anqing First People’s Hospital Affiliated to Anhui Medical University from January 2021 to September 2022 were extracted for retrospective analysis.The patients were divided into two groups:the postoperative delirium group(42 cases)and the postoperative non delirium group(66 cases)based on whether postoperative delirium occurred.Multivariate logistic regression was used to identify the risk factors for postoperative delirium in elderly patients with hip fractures after iliac fas-cial block.Receiver operating characteristic(ROC)curves were plotted to assess the predictive value of com-bined detection of NLR,INS and p-tua in elderly patients with hip fractures after iliac fascial block.Results There were significant differences in age,preoperative carotid artery stenosis,operation time,levels of whole blood NLR,INS and p-tua between the postoperative delirium and postoperative non delirium groups(χ^(2)=8.911,13.487,t=8.623,6.030,6.952,6.398,5.946,P<0.05).Multivariate logistic regression analysis showed that age≥60 years old,preoperative carotid artery stenosis,operation time≥2.5 hours and higher lev-els of whole blood NLR,INS and p-tua were independent risk factors for postoperative delirium in elderly hip fracture patients with iliac fascia block(OR=2.489,4.125,2.040,3.438,2.942,2.962,P<0.05).ROC curve analysis showed that the area under the curve(AUC)values of whole blood NLR,INS,and p-tua for the diagnosis of postoperative delirium in elderly hip fracture patients with iliac fascial block were 0.905,higher than those of the levels of whole blood NLR,INS and p-tua alone(0.762,0.718,0.777,P<0.05).Conclusion Postoperative delirium in elderly hip frac

关 键 词：髋部骨折 老年 髂筋膜阻滞 术后谵妄 危险因素 

分 类 号：R614[医药卫生—麻醉学]