多因素干预对高龄髋部骨折术后认知的影响

Effect of perioperative multifactorial intervention on postoperative cognition of surgical treatments for hip fractures in the elderly

摘要:

［目的］ 评价多因素干预对高龄患者髋部骨折术后认知的作用。［方法］ 2016 年 5 月—2021 年 5 月对 216 例老年髋部骨折患者行手术治疗，包括 PFNA、HA 和 THA 术。随机将患者分为干预组与对照组各 108 例。干预组于围手术期给予全身营养支持，多模式镇疼，及早输血矫正贫血，心理辅导和早期康复锻炼。对照组给予常规围手术期处理。比较两组近期临床效果，以及简易智力状态检查（Mini-Mental State Examination, MMSE） 结果。［结果］两组患者均顺利完成手术，术中无严重并发症。干预组术后下地行走时间、住院时间均显著优于对照组（P<0.05）。术后 1 个月和术后 6 个月时，干预组的 Harris 评分均显著高于对照组 （P<0.05）。围手术期干预组无认知功能障碍患者，对照组术后 6 例发生认知障碍，占 5.56%。术前 24 h 两组间 MMSE 评分的差异无统计学意义（P>0.05），术后 1~5 d 干预组的 MMSE 评分均显著高于对照组（P<0.05）。［结论］ 围手术期多因素干预能够有效降低认知障碍的发生，加速老年髋部骨折患者康复。

Abstract:

[Objective] To evaluate the effect of perioperative multifactorial intervention on clinical outcomes and postoperative cogni- tion of surgical treatments for hip fractures in the elderly. [Methods] From May 2016 to May 2021, 216 elderly patients who received surgi- cal treatments for hip fracturs involving PFNA, HA and THA were randomly divided into the intervention group and the control group, with 108 cases in each group. Of them, the patients in the intervention group received systemic nutritional support, multimodal pain manage- ment, active blood transfusion to correct anemia, psychological counseling and early rehabilitation exercise during the perioperative period, while those in the control group received routine perioperative management. The clinical results in short term and the data of mini-Mental State Examination (MMSE) were compared between the two groups. [Results] All the patients in both groups were successfully operated on without serious complications. The intervention group proved significantly superior to the control group in term of walking time and hospital stay (P＜0.05) , additionally the former got significantly higher Harris score than the latter at 1 and 6 months after surgery (P＜0.05) . No cog- nitive impairment happened in anyone of the intervention group, whereas 6 patients presented cognitive impairment in the control group, ac- counting for 5.56%. Although there was no significant difference in MMSE score between the two groups 24 h before surgery (P＞0.05) , the intervention group proved significantly superior to the control group in term of MMSE score from 1 day to 5 days postoperatively (P＜0.05) . [Conclusion] This perioperative multifactorial intervention does effectively reduce the occurrence of cognitive impairment, whereas acceler- ate the rehabilitation after surgical treatments for hip fractures in the elderly.