老年髋部骨折患者术后谵妄的危险因素分析及护理策略

Risk factors analysis of postoperative delirium in elderly patients with hip fracture and nursing strategies

目的探讨老年髋部骨折患者术后谵妄的危险因素及护理对策。方法选择衢州市人民医院2016年1月-2018年9月间收治的74例老年髋部骨折术后谵妄的患者为谵妄组,198例老年髋部骨折术后未发生谵妄的患者为未谵妄组。对2组患者性别、既往谵妄病史、入院前使用抗精神病药物、助听器使用、骨折类型、术前准备不充分、吸入麻醉、手术时间、术后有无低氧血症、术后发生剧烈疼痛等情况进行统计,并采用单因素和多因素分析确定老年髋部骨折患者术后谵妄的危险因素。结果单因素显示既往谵妄病史、入院前使用抗精神病药物、助听器使用、骨折类型、术前准备不充分、吸入麻醉、手术时间长、术后有低氧血症、术后发生剧烈疼痛是老年髋部骨折患者术后谵妄的危险因素。多因素logistic回归分析结果显示:既往谵妄病史、入院前使用抗精神病药物、助听器使用、骨折类型、术前准备不充分、吸入麻醉、手术时间长、术后有低氧血症、术后发生剧烈疼痛是老年髋部骨折患者术后谵妄的独立危险因素。结论既往谵妄病史、入院前使用抗精神病药物、助听器使用、骨折类型、术前准备不充分、吸入麻醉、手术时间长、术后有低氧血症、术后发生剧烈疼痛是老年髋部骨折患者术后谵妄的危险因素,临床中要重视危险因素,做好治疗和护理,预防术后谵妄的发生。

Objective To investigate the risk factors of postoperative delirium in elderly patients with hip fracture and the nursing strategies. Methods Seventy-four patients with postoperative hip fractures who underwent senile hip fracture between January 2016 and September 2018 were enrolled in the sputum group. One hundred and ninety-eight patients who had no sputum after hip fracture in the elderly were the sputum group. Two groups of gender, previous history of rickets, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, operation time, postoperative hypoxemia, severe pain after surgery The situation was statistically analyzed, and single factor and multivariate analysis were used to determine the risk factors for postoperative delirium in elderly patients with hip fracture. Results Univariate results showed that previous history of sputum, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, and presence or absence of hypoxia after surgery hypertension and severe postoperative pain were risk factors for postoperative delirium in elderly patients with hip fracture. Multivariate logistic regression analysis showed that previous history of sputum, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, and presence or absence of hypoxia after surgery hypertension and severe postoperative pain were risk factors for postoperative delirium in elderly patients with hip fracture. Conclusion The previous history of rickets, use of antipsychotics before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, postoperative hypoxemia, postoperative severe pain is elderly hip Risk factors for postoperative delirium in patients with fractures, risk factors should be emphasized in the clinic, and treatment and care should be done to prevent postoperative delirium.