高龄髋部骨折术后认知功能障碍的特点及防治康复措施

Clinical observation of postoperative cognitive dysfunction in elderly patients with hip fracture

目的探讨高龄髋部骨折患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的特点及防治康复措施。方法回顾性分析2011-01至2014-01收治的70岁以上髋部骨折手术患者120例的临床资料,其中术后出现POCD患者40例,探讨其临床特点、发生原因及防治措施。结果经对症处理及综合治疗后,25例术后1周内认知功能障碍好转,13例术后2周内好转,2例术后随访6个月仍有认知功能障碍。高龄髋部骨折POCD发病与术前认知障碍、围术期贫血、术中出血量及手术时间相关。结论认识到POCD不是单一因素造成的,也不是多种因素的简单相加,而是病因与疾病之间,甚至病因与病因之间的相互联系、相互作用的结果。

Objective To observe postoperative cognitive dysfunction（ POCD） in elderly patients with hip fracture,to understand its pathogenesis,clinical manifestations,give prevention and treatment measures to promote early rehabilitation of the patients.Method Clinical data of 120 hip fracture patients were retrospectively analyzed from January 2011 to January 2014 in this hospital.All patients＇ age were older than 70 years. There were 40 patients diagnosed as having POCD after surgery,to explore the clinical features,causes and prevention measures. Results After symptomatic treatment and comprehensive treatment,25 of 40 POCD patients＇ cognitive dysfunction improved within 1 week postoperatively,13 cases improved within 2 weeks after surgery. But 2 cases still had cognitive dysfunction 6 months postoperatively. Conclusions The incidence of POCD in elderly patients with hip fracture is associated with preoperative cognitive impairment,perioperative anemia,blood loss in operation and operation time. But we should be aware that POCD is not caused by a single factor,it is not a simple sum of a variety of factors,but the multiple factors interaction.