术后早期谵妄对关节置换术老年患者预后的影响

Effect of early postoperative delirium on outcomes in elderly patients undergoing joint replacement

目的评价术后早期谵妄对关节置换术老年患者预后的影响。方法择期髋关节或膝关节置换术老年患者，年龄≥60岁，ASA分级I-Ⅲ级。根据是否发生术后谵妄分为谵妄组和非谵妄组。设定病例匹配标准为年龄差值不超过5岁和Charlson合并疾病指数差值不超过2分，并以1：4匹配。记录术后28d内并发症的发生情况。谵妄组患者记录出现谵妄后发生的并发症。结果谵妄组53例，非谵妄组212例。2组患者术前基线资料和术中情况各指标比较差异无统计学意义（P〉0．05）。与非谵妄组比较，谵妄组患者术后并发症的总发生率升高，术后认知功能障碍、心血管并发症、肺部并发症和下肢静脉血栓形成的发生率升高，术后住院时间延长（P〈0．05）。结论术后早期谵妄不利于关节置换术老年患者的预后。

Objective To evaluate the effect of early postoperative delirium on outcomes in elderly patients undergoing joint replacement. Methods Elderly patients, aged 60 ≥yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective hip or knee joint replacement, were divided into delirium group and non-delirium group according to whether the patients developed postoperative deliri-um. The case-matching criteria was set up with difference in age less than 5 yr and difference in Charlson comorbidity index less than 2 and with a ratio of 1 ： 4 for match. The development of complications was re-corded within 28 days after operation. Complications happened after delirium was recorded in delirium group. Results There were 53 cases in delirium group and 212 cases in non-delirium group. There was no significant difference in preoperative baseline data or intraoperative variables between two groups （P 〉 O. 05). Compared with non-delirium group, the total incidence of postoperative complications was signifi-cantly increased, the incidence of postoperative cognitive dysfunction, cardiovascular complications, pul-rnonary complications and deep venous thrombosis was increased, and the length of hospitalization was pro-longed in delirium group （P〈0. 05）. Conclusion Early postoperative delirium is not helpful for outcomes in elderly patients undergoing joint replacement.