髋部骨折高龄患者围手术期谵妄临床分析

PERIOPERATIVE DELIRIUM IN THE ELDERLY WITH HIP FRACTURE

目的探讨高龄老人髋部骨折围手术期谵妄的诊断、治疗、康复和疗效。方法总结分析高龄（75岁以上）髋部骨折204例的临床资料，分析患者年龄、并存疾病、伤前活动能力、创伤心理、水电平衡等因素对谵妄产生的影响。结果围手术期共发生谵妄96例，发生率47．06％，患者伤前日常生活指数X2=6．62，P〈0．05）、伤前并存疾病X2=32．74，P〈0．01）、水电酸碱平衡（好=35．22，P〈0．01）对患者谵妄发生有统计学意义。结论高龄髋部骨折围手术期极易引起谵妄，术前须做好身体综合评估，纠正并存疾病，术后必须配合良好的康复治疗和社会家庭支持，则能显著提高患者伤后生活质量。

Objective To explore the diagnose, the treatment, the rehabilitation and the curative effect of perioperative delirium in the elderly with hip fracture. Methods Review the clinical data of 204 patients （ over 75 years old） with hip fracture, analyzing the affect of factors as age, coexisting disease, activity before injury, psychol- ogy of trauma and water - electrolyte balance on delirium. Results Perioperative delirium occurred in 96 cases （47.6%）. Patients before injury ADL index （ X2 = 6. 62 ,p 〈 0.05 ） , coexisting diseases （ X2 = 32. 74 ,p 〈 0. 01 ）, water electrolyte and acid - base balance （ Z2 = 35.22 ,p 〈 0. 01 ） affect on patients＇ delirium with statistical signifi- cance. Conclusion For elderly patients with hip fracture the perioprative delirium is apt to occur, so comprehensive evaluation of surgical tolerance and correct other diseases before operation are very important; with the support of so- cial and family and good rehabilitation, the quality of life after injury will be enhanced remarkably.