Mini-Cog量表预测老年髋部骨折术后谵妄风险

Predicting the risk of delirium in elderly patients after hip fracture surgery by using Mini-Cog test

[目的]研究老年髋部骨折患者术后谵妄状态的发生率及相关危险因素。探究Mini-Cog量表评分与谵妄发生的关系。[方法] 70例接受手术治疗的老年髋部骨折患者,收集患者术前血清钠离子浓度、术前牵引制动、术前卧床天数、手术时间、术后3 d血色素下降值、吗啡类药物使用、术后入外科监护室、术后7 d内是否出现谵妄等信息,计算患者Charlson共病指数,进行MMSE量表和Mini-Cog量表评分并记录所用时间。[结果]术后7 d内有28例(40.00%)患者出现谵妄状态。与非谵妄组相比,谵妄组患者术前卧床时间长(P<0.05),术前血清钠离子浓度值低(P<0.05),术后3 d血色素下降多(P<0.05),术前Charlson共病指数高(P<0.05);此外,谵妄组评估术前认知状态的MMSE和Mini-Cog量表评分显著低于非谵妄组(P<0.05)。逻辑回归分析显示:术后谵妄与术前卧床时间、术前血清钠离子浓度、术后3 d血色素下降值、术前Charlson共病指数、术前MMSE量表评分和Mini-Cog量表评分相关。完成Mini-Cog量表时间(3.88±1.67) min,显著低于MMSE量表(12.28±4.84) min (P<0.001)。[结论]老年髋部骨折患者术后谵妄状态的发生与术前卧床时间、术前血清钠离子浓度、术前Charlson共病指数、术前MMSE量表评分和Mini-Cog量表评分相关。评估认知功能障碍的Mini-Cog量表可以简单有效地筛选老年髋部骨折术后谵妄发生的高危患者。

[Objective] To explore the incidence of postoperative delirium and its risk factors in elderly patients with hip fractures, and the relationship between Mini-Cog test and delirium. [Methods] A total of 70 elderly patients who underwent surgical treatment for hip fractures in our hospital were included into this study. The clinical variables were documented, includingpreoperative serum sodium, preoperative traction, preoperative bed-rest time, operation time, decline of hemoglobin at 3 days after surgery, morphine consumed, intensive care unit stay, Charlson comorbidity index, and onset of delirium within 7 days after surgery. In addition, all the patients were assessed by using MMSE and Mini-Cog by the primary nurse, and the time elapsed were documented. [Results] Twenty-eight patients(40%) developed delirium within 7 days after operation. The delirium group had significantly longer preoperative bed-rest time(P<0.05), lower preoperative serum sodium(P<0.05), greater decline of hemoglobin at 3 day after operation(P<0.05), higher Charlson comorbidity index(P<0.05) than the non-delirium group. In addition, the delirium group was marked significantly lower MMSE and Mini-Cog scores than the non-delirium group(P<0.05). As results of single factor logistic analysis, preoperative bed-rest time, preoperative serum sodium, decline of hemoglobin at 3 days after operation, Charlson comorbidity index, MMSE score and Mini-Cog score were related to postoperative delirium. The time consumed in the Mini-Cog test was significantly less than that in MMSE [(3.88±1.67) min versus(12.28±4.84) min, P<0.05].[Conclusion] The onset of postoperative delirium in elderly after operation for hip fractures is associated with preoperative bedrest time, preoperative serum sodium, decline of hemoglobin at 3 days after operation, Charlson comorbidity index, and preoperative Mini-Cog score and MMSE score. Mini-Cog is a simple and effective way to predict the risk of delirium in elderly after hip fracture surgery.