股骨粗隆间骨折闭合复位内固定术后谵妄的临床危险因素分析  

The analysis of clinical risk factors for postoperative delirium after closed reduction and internal fixation of intertrochanteric femoral fracture

作　　者：王浩宇 钱钧 何飞熊 徐江保 Wang Haoyu

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院),324000

出　　处：《浙江临床医学》2025年第2期187-189,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医学会临床医学专项资金项目(2022ZYC-B22)。

摘　　要：目的探讨老年股骨粗隆间骨折患者术后发生谵妄的危险因素,并探讨有效的防治策略。方法回顾性收集2022年1月至2023年12月期间在本院骨科接受股骨粗隆间骨折闭合复位内固定手术的161例老年患者(年龄≥65岁)的临床资料。研究分析了患者的年龄、性别、手术时间、术前准备时间、围手术期白蛋白变化、围手术期血红蛋白变化、术中输血、围手术期失眠、术前疼痛评分、麻醉方式、住院时间及术中氨甲环酸使用等临床相关因素。首先进行单因素分析,然后采用Logistic预测模型进行多因素分析。结果161例患者中,男性59例,女性102例,平均年龄81.58±8.18岁(65~97岁)。术后发生谵妄39例,发生率为24.22%。二元Logistics回归模型分析显示,年龄(P=0.013)、失眠(P=0.018)、术前白蛋白(P=0.004)、术前准备时间>2 d(P=0.030)以及输血浆(P=0.032)在谵妄和非谵妄患者之间差异具有统计学意义。结论高龄、术前失眠、术前白蛋白低、术前准备时间>2 d是术后发生谵妄的独立危险因素。术中输血浆能降低谵妄的发生率。Objective To explore the risk factors for postoperative delirium in elderly patients with intertrochanteric femoral fractures and to investigate effective prevention and treatment strategies.Methods A total of 161 eldly patients(aged≥65 years)with femoral intertrochanteric fracture who underwent closed reduction and internal fixation surgery at our hospital's orthopedics department from January 2022 to December 2023 were retrospectively analyzed.The study analyzed clinical factors such as patient age,gender,surgery time,preoperative preparation time,perioperative albumin changes,perioperative hemoglobin changes,intraoperative blood transfusion,perioperative insomnia,preoperative pain scores,anesthesia methods,hospital stay,and use of tranexamic acid during surgery.Univariate analysis was performed first,followed by multivariate analysis using the logistic regression model.Results Among the 161 patients,there were 59 males and 102 females,with an average age of 81.58±8.18 years(65 to 97 years old).Delirium occurred in 39 cases after surgery,with an incidence rate of 24.22%.Binary logistic regression model analysis showed that age(P=0.013),insomnia(P=0.018),preoperative albumin(P=0.004),preoperative preparation time>2 days(P=0.030),and plasma transfusion(P=0.032)had statistically significant differences between delirious and non-delirious patients.Conclusion Advanced age,preoperative insomnia,low preoperative albumin,and preoperative preparation time>2 days are independent risk factors for delirium.Intraoperative plasma transfusion can reduce the incidence of delirium.

关 键 词：股骨粗隆间骨折 谵妄 危险因素 闭合复位内固定 

分 类 号：R687.3[医药卫生—骨科学]