老年髋部骨折患者围术期谵妄状态病因分析

Etiology analysis of perioperative delirium in elderly hip fracture

目的分析老年髋部骨折患者围术期谵妄的发病原因。方法对108例老年髋部骨折患者入院后使用谵妄诊断标准(confusion assessment method,CAM)每日评估1次,及时诊断谵妄状态,记录谵妄状态患者临床资料,分析谵妄状态发生的病因,继而进行针对性病因治疗后记录临床治疗效果(实验组),并与查阅的既往病例(对照组)比较。结果 24例(22.2%)患者在围术期出现谵妄状态,病因分析发现谵妄状态常由多种原因共同导致,最常见的原因是感染、心肺功能衰竭和(或)缺氧、水电解质紊乱、药物等。经病因治疗后实验组与对照组比较,住院时间明显缩短(P=0.021)。结论髋部骨折患者围术期谵妄发生率高,严重影响患者的健康恢复。谵妄常常由多个致病因素共同作用所致,通过对谵妄患者进行针对性的病因治疗,可使其获得明显的临床改善。

Objective To analyze the etiology of perioperative delirium in the patients with elderly hip fracture.Methods 108 inpatients with elderly hip fracture were evaluated for timely diagnosing delirium state by the confusion assessment method（CAM） after admission,then once daily.Once delirium happening,the clinical data were recorded and the etiology was analyzed.Then,the pertinent etiological treatment was performed.The clinical effects（experimental group）were recorded and compared with previous cases of delirium（control group）.Results 24 cases（22.2%） were diagnosed delirium in perioperative period.Etiological analysis found that delirium state was often caused by a variety of causes,the most common causes were infection,fluid-electrolyte disturbances,cardiopulmonary function failure and/or hypoxia and medication.Comparing the experimental group after treatment with the control group,the length of hospital stay was obviously shortened（P=0.021）.Conclusion Perioperative delirium in elderly hip fractures has a high incidence and seriously affect the patient′s health recovery.Delirium is often caused by the combined effects of multiple etiologies.Significant clinical improvement could be acquired through pertinentl etiological treatment.