老年髋部骨折术后谵妄的危险因素

Risk factors of delirium after surgeries for hip fractures in the elderly

摘要:

［目的］ 探讨老年髋部骨折患者术后发生谵妄风险的影响因素分析。［方法］ 2015 年 8 月—2019 年 8 月于本院行手术治疗的老年髋关节骨折患者 308 例纳入本研究，依据术后是否发生谵妄将患者分为两组，采用单项因素比较，以及以是否发生谵妄的二分变量为因变量，其他因素为自变量的多元逻辑回归，探索手术后发生谵妄风险的相关因素。［结果］ 308 例患者中，谵妄发生 62 例，占 20.13%。谵妄发生时间为术后 1~7 d，平均发生时间 （4.56±1.53） d。单项因素比较表明：谵妄组年龄、II 型糖尿病比率、ASA 分级、全麻比率、术中失血量和手术时间均显著大于非谵妄组 （P<0.05）。多因素逻辑回归表明： 高龄 （OR=1.254，P<0.05）、II 型糖尿病 （OR=4.602，P<0.05）、ASA 分级高 （OR=5.407，P<0.05）、全身麻醉 （OR=4.766，P< 0.05） 及手术时间长 （OR=1.129，P<0.05） 是术后谵妄的独立危险因素。［结论］ 老年髋部骨折术后患者谵妄风险因素是高龄、II 型糖尿病、ASA 分级高、全身麻醉和手术时间长。

Abstract:

[Objective] To explore factors related to delirium after operation for hip fractures in the elderly. [Methods] A total of 308 elderly patients who underwent surgical treatment for hip fractures in our hospital from August 2015 to August 2019 were included in this study. The patients were divided into two groups based on whether delirium occurred postoperatively, and univariate comparison and binary multiple logistic regression were conducted to search the factors related the postoperative delirium. [Results] Among 308 patients, 62 pa- tients were diagnosed of delirium after operation, accounting for 20.13%. The onset time of delirium ranged from 1 to 7 days after operation, with an average time of (4.56±1.53) days. In term of univariate comparison, the delirium group proved significantly greater than the non-de- lirium group regarding to the age, type II diabetes incidence, ASA grade, general anesthesia ratio, intraoperative blood loss and operation time (P<0.05) . As results of multivariate logistic regression, the advanced age (OR=1.254, P<0.05) , type II diabetes (OR=4.602, P<0.05) , high ASA grade (OR=5.407, P<0.05) , general anesthesia (OR=4.766, P<0.05) and long operation time (OR=1.129, P<0.05) were of inde- pendent risk factors for postoperative delirium. [Conclusion] The risk factors of delirium after surgical treatment for hip fractures in the el- derly include advanced age, type II diabetes, high ASA grade, general anesthesia and long operation time.