高龄髋部骨折患者术后急性意识障碍的危险因素及防治对策

Risk factors and strategies of acute consciousness disorder of elderly patients with hip fracture

目的探讨高龄髋部骨折患者术后急性意识障碍的危险因素及防治对策。方法回顾分析2014年2月~2017年2月在唐山市第二医院进行手术治疗的229例高龄髋部骨折患者的临床资料,对患者术后急性意识障碍的发生情况、临床特点、危险因素进行分析并探讨防治对策。结果 229例高龄髋部骨折患者术后发生急性意识障碍62例,发生率为27.07%。单因素分析结果显示,髋部骨折患者术后急性意识障碍的发生率在年龄、术后感染、糖尿病、不良心理因素、麻醉持续时间、麻醉方式、手术时间、术中出血量、术后疼痛评分方面的差异有统计学意义(P<0.05)。多因素Logistic分析结果显示,年龄>70岁、术后感染、糖尿病、不良心理因素、麻醉方式、术中出血量、术后疼痛评分均是影响急性意识障碍发生的独立因素(OR=3.656、1.857、2.556、2.031、1.965、2.062、2.607,均P<0.05)。结论年龄>70岁、术后感染、糖尿病、存在不良心理因素、全身静脉麻醉、术中出血量多及术后疼痛评分高均是导致急性意识障碍发生的高危因素,临床应予以重视,给予精细护理并加强对高龄髋部骨折患者围术期的监护。

Objective To explore the risk factors of postoperative acute consciousness disorder of elderly patients with hip fracture and control measures. Methods Clinical data of 229 cases of elderly patients with hip fracture treated in the Second Hospital of Tangshan City from February 2014 to Febmaly 2017 were analyzed retrospectively. The incidence,clinical features and risk factors of postoperative acute conscious disturbance were analyzed, and then prevention and cure measures were discussed. Results Of 229 elderly patients with hip fracture, there were 62 cases of postoperative acute consciousness disorders, with the rate of 27.07%. Single factor analysis result showed that there were significant difference in age, postoperative infection, diabetes, adverse psychological factors, duration of anesthesia, mode of anes-thesia, time of operation, intraoperative blood loss, postoperative pain score of postoperative acute consciousness disor- ders of elderly patients with hip fracture （P 〈 0.05）. Multivariate Logistic analysis result showed that, age over 70 years,postoperative infection, diabetes, adverse psychological factors, anesthesia, intraoperative blood loss, postoperative pain scores were independent factors influencing the occurrence of acute consciousness disorders （OR=3.656, 1.857, 2.556, 2.031, 1.965, 2.062, 2.607, all P 〈 0.05）. Conclusion The risk factors of acute consciousness disorders are age more than 70 years, postoperative infection, diabetes, adverse psychological factors, general intravenous anesthesia, intraop-erative blood loss more and postoperative pain scores high. It should pay attention in clinical, and give intensive nuts-ing, and strengthen perioperative care of elderly patients with hip fracture.