高龄髋部骨折患者术后谵妄发生的影响因素分析

Analysis on the influencing factors of postoperative delirium in the elderly patients with hip fracture

目的探讨高龄髋部骨折患者术后谵妄发生的影响因素。方法回顾性分析2015年1月～2017年12月我院收治的100例高龄髋部骨折患者的临床资料,根据患者有无发生术后谵妄分为研究组(有术后谵妄,n=25)与对照组(无术后谵妄,n=75)。比较两组的临床资料,采用多元Logistic回归分析高龄髋部骨折患者手术后谵妄发生的影响因素。结果研究组的年龄>80岁、术前清蛋白水平<35 g/L、全身麻醉、手术时间≥2.5 h、术后使用镇痛泵、术后低氧血症及术前合并基础疾病≥2项发生率均高于对照组,差异有统计学意义(P<0.05);两组患者的性别、BMI、术前血红蛋白水平、骨折类型、受伤至手术时间、手术方式和术中出血量比较,差异无统计学意义(P>0.05)。多元Logistic回归分析结果显示,年龄、术前清蛋白水平、手术时间及术前合并基础疾病是高龄髋部骨折患者发生术后谵妄的独立危险因素(P<0.05)。结论高龄髋部骨折患者术后谵妄发生情况的独立危险因素包括高龄、术前白蛋白(<35 g/L)、术前合并基础疾病数量(≥3种)、手术时间(≥2.5 h),临床需加强重视。

Objective To explore the influencing factors of postoperative delirium in elderly patients with hip fracture.Methods The clinical data of 100 elderly patients with hip fracture admitted to our hospital from January 2015 to December 2017 were retrospectively analyzed,the patients were divided into study group(with postoperative delirium,n=25)and control group(without postoperative delirium,n=75)according to the occurrence of postoperative delirium.The clinical data of the two groups were compared,and the influencing factors of delirium in elderly patients with hip fracture after operation were analyzed by multiple Logistic regression.Results The incidence of age>80 years old,preoperative albumin level<35 g/L,general anesthesia,operation time(>2.5 h),postoperative use of analgesic pump,postoperative hypoxemia and preoperative complications of basic diseases(≥2 items)in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in gender,BMI,preoperative hemoglobin level,fracture type,time from injury to operation,operation method and intraoperative bleeding between the two groups(P>0.05).Multivariate Logistic regression analysis showed that age,preoperative albumin level,operation time and preoperative complications of basic diseases were independent risk factors for delirium in elderly patients with hip fracture(P<0.05).Conclusion Independent risk factors for delirium after hip fracture surgery in elderly patients include age,preoperative albumin(<35 g/L),number of preoperative complications of basic diseases(>3 items),operation time(>2.5 h),which should be paid more attention to clinically.