老年股骨转子间骨折患者内固定术后发生谵妄的危险因素分析

Risk factors for delirium after intertrochanteric fracture surgery in the elderly

目的探讨老年股骨转子间骨折患者内固定术后发生谵妄的相关危险因素。方法回顾性分析2010年12月至2018年4月期间保定市第二中心医院骨科接受闭合复位股骨近端防旋髓内钉固定治疗的423例股骨转子间骨折患者资料。男205例,女218例;年龄为70~98岁,平均78.6岁;骨折AO分型:31-A1型239例,31-A2型141例,31-A3型43例;362例患者合并内科疾病。受伤至手术时间为4~72 h,平均46.6 h。统计患者术后发生谵妄的情况。对患者的隐性失血量、性别、年龄、体重指数、并发症情况、麻醉方式、术前准备时间及电解质紊乱情况等进行单因素分析筛选危险因素,对于P<0.05的因素再采用多因素logistic回归分析确定主要的独立危险因素。结果423例患者中49例(11.58%)术后发生谵妄,其中29例发生于术后第1天,20例发生于术后第2天;374例(88.42%)患者未发生谵妄。单因素分析结果显示:发生谵妄患者与未发生谵妄患者在受伤至手术时间、隐性失血量及电解质紊乱方面比较差异均有统计学意义(P<0.05)。多因素logistic回归分析显示:受伤至手术时间>48 h(OR=3.386,95%CI:1.362~6.638)、隐性失血量>600 mL(OR=10.292,95%CI:1.244~35.091)、术后电解质紊乱(OR=4.157,95%CI:1.595~7.626)是老年股骨转子间骨折患者内固定术后发生谵妄的独立危险因素。结论受伤至手术时间长、隐性失血量多与术后发生电解质紊乱是老年股骨转子间骨折患者内固定术后发生谵妄的独立危险因素。

Objective To investigate the risk factors for delirium after intertrochanteric fracture surgery in the elderly.Methods The data of 423 elderly patients with femoral intertrochanteric fracture were retrospectively analyzed who had been treated by closed reduction and internal fixation with proximal femoral nail antirotation(PFNA)at Department of Orthopedics,The Second Central Hospital of Baoding from December 2010 to April 2018.They were 205 males and 218 females,aged from 70 to 98 years(mean,78.6 years).By AO classification,239 fractures were type 31-A1,141 ones type 31-A2,and 43 ones type 31-A3.Of them,362 were complicated with disease of internal medicine.The interval from injury to surgery ranged from 4 to 72 hours with an average of 46.6 hours.The incidence of postoperative delirium was recorded.The risk factors were screened by univariate analysis from the hidden blood loss,gender,age,body mass index,complications,anesthesia method,preoperative preparation time and electrolyte disturbance;multivariate logistic regression analysis was used to determine the independent risk factors from the factors with P<0.05.Results Post-operative delirium occurred in 49 of the 423 patients(11.58%)(29 cases on the first postoperative day and 20 ones on the second postoperative day).It was not observed in the other 374(88.42%)patients.Univariate analysis showed significant differences in the interval from injury to surgery,hidden blood loss and electrolyte disturbance between the patients with and without postoperative delirium(P<0.05).Multivariate logistic regression analysis showed that the interval from injury to surgery>48 hours(OR=3.386,95%CI:1.362 to 6.638),hidden blood loss>600 mL(OR=10.292,95%CI:1.244 to 35.091)and electrolyte disturbance(OR=4.157,95%CI:1.595 to 7.626)were the independent risk factors for postoperative delirium in elderly patients with intertrochanteric fracture.Conclusion Long preoperative preparation,a large amount of hidden blood loss and postoperative electrolyte disturbance may be the risk factors for post-operative delirium in elderly patients with intertrochanteric fracture afterinternal fixation.