老年髋部骨折术后血容量改变与谵妄的相关分析

Correlation analysis of postoperative blood volume changes and delirium in elderly patients undergoing surgery for hip fracture

目的探讨谵妄与老年髋部骨折患者术后血容量改变的相关性，为治疗和预防提供参考。方法连续性观察150例接受手术治疗的老年髋部骨折患者。谵妄的评估采用CAM（confusionassessmentmethod）量表。收集其术前、术中及术后的数据，用Logistic回归分析血容量改变与谵妄的相关性。结果59例患者（男28例，女31例）术后出现了谵妄，发生率为39．3％（59／150）。谵妄组平均年龄（77．71±6．63）岁，高于无谵妄组患者（73．79±5．42）岁，两组比较差异有统计学意义（t=-3．958，P〈0．001）。谵妄组患者术前及术后第7天平均血红蛋白浓度、红细胞比容均低于未出现谵妄组[术前分别为（117．80±16．59）、（123．92±14．61）g／L，t=2．378，P=0．019；0．355±0．154、0．372±0．210，t=2．291，P=0．023；术后第7天（98．15±11．51）、（102．33±9．88）g／L，t=2．369，P=0．019；0．296±0．040、0．306±0．030，t=-3．958，P〈0．001]。两组间在性别、骨折类型、手术方式、手术时间、失血量及术后1、3d血红蛋白浓度间差异无统计学意义（P均〉0．05）。经Logistic回归分析，患者的年龄、教育程度及术后第7天血红蛋白含量在是否出现谵妄两组间差异有统计学意义（OR分别为3．28、1．097、0．389，P均〈0．05）。结论高龄髋部骨折患者发生谵妄是一个多因素结果，高龄、术后持续低血红蛋白浓度、受教育程度低患者的谵妄发生概率高。

Objective To explore the relationship of blood volume changes and postoperative delirium in elderly patients undergoing surgery for hip fracture. Methods One hundred and fifty elderly patients who underwent surgery for hip fracture were enrolled in the study. Delirium was diagnosed by Confusion Assessment Method（ CAM ）. Preoperative, intraoperative and postoperative data were collected, and the correlation of postoperative delirium and blood volume changes were analyzed by logistic regression analysis. Results A total of 59 patients （28 males and 31 females）had delirium after surgery and the occurrence rate of postoperative delirium was 39. 3% （59/150）. The average age in delirium group was significantly older than that in the control group [ （77. 71 ± 6. 63 ）years old vs（73.79 ± 5.42 ）years old, t = -3. 958, P 〈 0. 001 ]. The average hemoglobin concentration and hematocrit in delirium group were both less than that in control group whether before surgery or at 7 days after surgery （ before surgery ： average hemoglobin concentration： [ （ 117.80 ± 16. 59 ） g/L vs （ 123.92 ±14. 61 ） g/L, t = 2. 378, P = 0. 019 ; hematocrit： （0. 355 ± 0. 154） vs （0. 372 ± 0. 210 ）, t = 2. 291, P = 0. 023 ; 7 days after surgery： average hemoglobin concentration ： （ 98.15 ±11.51 ） g/L vs （ 102. 33 ±9. 88 ） g/L, t = 2. 369, P=0.019;hematocrit： （0.296 ±0.040）vs（0.306±0.030）,t = -3.958,P 〈 0.001].There was no significant difference on gender, fracture type, surgical approach, operative time, blood loss and hemoglobin concentration at 1,3 days after surgery between the two groups（ P 〉 0. 05 ）. Logistic regression analysis showed that age （ OR 3. 280 ）, education （ OR 0. 389 ）, and hemoglobin concentration at 7 days after operration （ OR 1. 097 ） were significantly related to the occurrence of postoperative delirium （ P 〈 0. 05 ）. Conclusion Our findings suggest that the risk for postoperative delirium is the result of more than one factor. Older age, continued postoperative low hemoglobin concentration and low degree of education present high risk of delirium in patients underwent surgery for hip fractures.