集束化护理预防老年髋部骨折术后谵妄的效果

Bundles of care prevents postoperative delirium in elderly patients with hip fractures

目的探讨集束化护理预防老年髋部骨折术后谵妄的效果。方法采用前瞻性病例对照研究分析2017年3月-2017年6月收治的80例老年髋部骨折患者的临床资料，按随机数字表法分为研究组（43例）和对照组（37例）。研究组采用集束化护理，对照组采用常规护理。两组均采用相应术式治疗，采用意识模糊评估法（CAM）对术后谵妄进行诊断。比较两组性别、年龄、骨折类型、受伤至手术时间、内固定类型、手术时间、总出血量、视觉模拟评分（VAS）、谵妄发生率、并发症及不良事件发生率等。结果80例老年髋部骨折患者中男11例，女69例；年龄65～95岁，平均79．3岁。研究组和对照组性别（男6例：5例，女37例：32例）、年龄[79．8±7．8）岁：（78．7±8．9）岁]、致伤原因（交通伤7例：4例，跌伤36例：33例）、受伤至手术时间[（66．1±14．3）h：（63．4±14．9）h]、骨折类型（股骨颈、转子间、转子下13例：10例、26例：24例、4例：3例）、内固定类型[人工全髋、人工股骨头、股骨近端防旋髓内钉（PFNA）5例：5例、8例：5例、29例：27例）、手术时间[（55．5±16．8）min：（51．6±17．0）min]、总出血量[（114．4±73．9）ml：（108．1±72．0）ml]等方面差异均无统计学意义（P〉0．05）。研究组术后VAS[（2．2±0．8）分：（4．3±1．2）分]、术后谵妄发生率（9％：32％）、并发症及不良事件发生率（2％：19％）等均较对照组显著下降（P〈0．05）。结论集束化护理措施可减轻患者疼痛，有效降低老年髋部骨折患者术后谵妄发生率、并发症及不良事件发生率。

Objective To evaluate the effect of bundles of care on the prevention of postoperative delirium among elderly patients with hip fractures. Methods A prospective randomized case control study was conducted on 80 patients （ ≥65 years old） with hip fractures from March 2017 to June 2017. The patients were divided into experimental group （ n = 43 ） and control group （ n = 37 ） according to the random number table method. The experimental group received bundles of care, while the control group received routine nursing. The patients in both groups were all surgically treated, and the confusion assessment method （CAM） was applied to diagnose delirium after surgery. Gender, age, fracture type, duration from injury to operation, internal fixation type, operation time, total amount of bleeding, visualanalogue scale （VAS） , incidence of delirium, complications, and adverse events were compared between the two groups. Results Among the 80 patients, there were 11 males and 69 females, aged averagely 79.3 years （range, 65-95 years）. No significant differences were found between experiment group and control group in terms of gender （male： 6 cases vs. 5 cases, females： 37 cases vs. 32 cases）, age [ （79.8 ± 7.8） years vs. （78.7 ±8.9） years ], cause of injury （ traffic injuries ： 7 cases vs. 4 cases; falling injuries： 36 cases vs. 33 cases）, duration from injury to operation [ （66. 1 ± 14.3）hours vs. （63.4 ± 14.9） hours], fracture type （femoral neck： 13 cases vs. 10 cases; intertrochanteric： 26 cases vs. 24 cases; subtrochanteric： 4 cases vs. 3 cases）, internal fixation type （artificial total hip： 5 cases vs. 5 cases; artificial femoral head： 8 cases vs. 5 cases; PFNA： 29 cases vs. 27 cases） , operation time [ （55.5 ± 16.8） minutes vs. （51.6 ± 17.0）minutesl , total blood loss [ （114.4 ±73.9）ml vs. （108.1 ± 72.0） ml ] （P 〉 0.05 ）. After bundles of care intervention, the postoperative VAS [ （2.2 ± 0.8 ） points vs. （4.3 ±1.2） points], postoperative delirium incidenee （9% vs. 32% ）, incidence of complications and adverse events （2% vs. 19% ） in experimental group were significantly lower than those in control group （ P 〈 0.05 ）. Conclusion Bundles of care can relieve the pain and effectively reduce the incidences of postoperative delirium, complications, and adverse events in elderly patients with hip fracture.