老年人髋部骨折围手术期精神障碍

Perioperative delirium in the elderly with hip fracture

目的研究老年人髋部骨折围手术期精神障碍的发生、预防、治疗及其影响因素。方法采用美国精神障碍诊断标准（DSMIV）诊断老年人髋部骨折围手术期精神障碍，回顾性分析148例老年人髋部骨折的手术治疗，按临床特点进行分类，并将精神障碍组与无精神障碍组之间的数据进行统计学分析。结果本组患者围手术期26例（17．6％）出现精神障碍，平均持续时间为3d，其中22例（84．6％）发生于术后。所有围手术期精神障碍中，狂躁型15例（57．7%）、抑制型4例（15．4％）、混合型7例（26．9％），无围手术期精神障碍者平均年龄（75．5±7．0）岁，围手术期精神障碍者平均年龄（79．6±7．7）岁（t=2．668，P=0．008）。5例有既往精神障碍史的患者均出现围手术期精神障碍，5例外固定架治疗者均未出现围手术期精神障碍。结论围手术期精神障碍是在老年人中枢神经系统功能退化的基础上，由多种因素引起，影响老年人髋部骨折患者的预后，应将其作为一个独立的病症对待，采取积极的综合防治措施。

Objective To assess the influencing factors of perioperative delirium in the elderly with hip fracture and to define strategies for prevention and management. Methods DSM-Ⅳ was adopted to diagnosis of perioperative delirium in the elderly with hip fracture. The data of 148 elderly patients with hip fracture were analyzed retrospectively and classified according to the clinical characteristics. The differences were analyzed statistically between the delirious group and the control group. Results There were 26 （17.6%） cases diagnosed with delirium in the perioperative period, including 22 cases with postoperative delirium, and the delirious symptom lasted 3 days in average. For the type of delirium, there were 15 cases with mania type, 4 cases with inhibitory type and 7 cases with mixed type. Compared with patients in control group, patients with perioperative delirium were older （（79.6±7.7） years old vs. （75.5±7.0）years old, t=2.668, P=0.008））. Five cases who had previous delirium occurred perioperative delirium, and five patients who received external fixator showed no perioperative delirium. Conclusions Perioperative delirium is a heterogeneous symptom on the basis of brain aging and degeneration. It affects the prognosis of the elderly patients with hip fracture and should be viewed as a separate entity, which can be prevented and treated through comprehensive management.