高龄髋部骨折患者术后发生谵妄的危险因素分析

Analysis of the Risk Factors of Postoperative Delirium in Elderly Patients with Hip Fracture

目的:探讨高龄(≥75岁)髋部骨折患者术后发生谵妄的危险因素。方法:回顾性分析2014年1月至2016年12月收治的292例高龄髋部骨折患者临床资料(股骨颈骨折181例、股骨转子间骨折111例)。根据术后患者是否发生谵妄分为谵妄组(60例)和非谵妄组(232例)。对2组患者年龄、性别、骨折类型、术前血红蛋白、术前白蛋白、术前动脉血氧分压(PaO2)、并存病、待手术时间、手术方式、手术时间、术中出血量及输血量等因素进行单因素分析,然后应用Logistic回归进行多因素分析。结果:单因素分析结果显示,2组患者在年龄、术前血红蛋白、术前白蛋白、术前PaO2、并存病、待手术时间等方面比较差异有统计学意义(P<0.05)。多因素分析结果显示,年龄[OR=0.911,95%CI(0.857~0.968)]是术后发生谵妄的独立危险因素。2组患者住院期间肺部感染、泌尿系感染、伤口感染、心脑血管事件、术后低蛋白血症及下肢深静脉血栓发生率比较差异无统计学意义(P>0.05)。结论:高龄髋部骨折术后谵妄发生率较高,年龄是高龄髋部骨折患者发生谵妄的危险因素。

Objective:To explore the risk factors of postoperative delirium in elderly patients(≥75 years)with hip fracture.Methods:Clinical data of 292 elderly patients who were hospitalized from January,2014 to December,2016 were retrospectively analyzed(181 cases of transcervical fracture and 111 cases of intertrochanteric fracture).They were divided into delirium group(60 cases)and non delirium group(232 cases)according to whether postoperative delirium happen in the patients.To analyze the age,gender,bone fracture type,preoperative hemoglobin,preoperative albumin,preoperative arterial PaO2,complications,waiting time,surgical modes,surgical time,intraoperative blood loss and blood transfusion volume between both groups,and Logistic regression was used to perform multi-factor analysis.Results:Single-factor analysis indicated that the difference had statistical meaning in age,preoperative hemoglobin,preoperative albumin,preoperative arterial PaO2,complications,waiting time and others between both groups(P<0.05).The results of multi-factor analysis indicated that age[OR=0.911,95%CI(0.857~0.968)]was the independent risk factor in the incidence of postoperative delirium.The difference had no statistical meaning in the incidences of pulmonary infection,urinary infection,wound infection,cardiovascular and cerebro-vascular event,postoperative hypoproteinemia and deep venous thrombosis of lower limbs during hospitalization period(P>0.05).Conclusion:Postoperative delirium in elderly patients with hip fracture are in higher incidence,and age is the risk factor for delirium in elderly patients with hip fracture.