老年髋部骨折术后谵妄的危险因素分析

Risk factors of delirium after surgical treatment for hip fractures in elderly

摘要:

[目的]探讨老年髋部骨折术后谵妄的危险因素。[方法]回顾性分析 2016 年 12 月—2019 年 12 月南京江北医院骨科中心 346 例髋部骨折患者的临床资料，其中股骨颈骨折 160 例，股骨粗隆间骨折 164 例，股骨粗隆下骨折 22 例，根据是否发生术后谵妄，将患者分为两组。采用单项因素和二元多因素逻辑回归分析术后谵妄的危险因素。[结果]本研究的 346 例患者中，48 例确诊为术后谵妄，发生率 13.87%，发生于术后 2~7 d 内。单项因素与逻辑回归表明：高龄 (OR=2.329，P= 0.024)、受教育程度低(OR=1.957，P= 0.036)、有脑卒中史(OR=3.007，P=0.001)、独居(OR=1.933，P=0.037)、有睡眠紊乱史 (OR=2.789，P=0.005)、术前卧床时间长 (OR=2.056，P=0.026)、全身麻醉 (OR=2.196，P=0.013)、麻醉时间长 (OR= 2.229，P=0.012)、入 ICU 治疗 (OR=2.352，P=0.008) 是术后谵妄的独立危险因素。[结论] 高龄髋部骨折术后发生谵妄，极易影响预后，高龄、教育程度低、独居、脑卒中、睡眠紊乱史、术前卧床时间长、全身麻醉、麻醉时间长、术后转入 ICU 治疗均是主要危险因素，临床医师应加强重视。

Abstract:

[Objective] To explore the risk factors of delirium after surgical treatment of hip fractures in the elderly. [Methods] A retro- spective study was conducted on 346 patients who received surgical treatments for hip fractures in our hospital from December 2016 to De- cember 2019. According to whether or not postoperative delirium happened , the patients were divided into two groups. The univariate com- parison and binary multiple logistic regression were done to search the risk factors related to the postoperative delirium. [Results] Of the 346 patients, 48 patients were definitively diagnosed of postoperative delirium, accounted for 13.87%, which occurred within 2~7 days after surgery. As results of the univariate analysis and logistic regression, the advanced age (OR=2.329, P=0.024) , low education level (OR= 1.957, P=0.036) , stroke history (OR=3.007, P=0.001) , living alone (OR=1.933, P=0.037) , history of sleep disturbance (OR=2.789, P= 0.005) , preoperative bed time (OR=2.056, P=0.026) , general anesthesia (OR=2.196, P=0.013) , longer anesthesia time (OR=2.229, P= 0.013) , ICU stay (OR=2.352, P=0.008) were independent risk factors of postoperative delirium. [Conclusion] Postoperative delirium is a common complication after surgical treatment for hip fractures in the elderly, which does affect the prognosis. Advanced age, low education level, living alone, stroke history, sleep disturbance history, long bed time before surgery, general anesthesia, long anesthesia and ICU stay are the main risk factors, clinicians must pay more attention to them.