建立老年全髋关节置换术后谵妄风险预测模型的临床研究

Clinical study on the risk prediction model of delirium after total hip replacement in elderly patients

目的本研究的目的是通过分析老年全髋关节置换患者术后相关危险因素,建立65岁以上患者行全髋关节置换术后发生谵妄的列线图。方法回顾性收集2015~2016年208例在广东医科大学附属医院骨科行全髋关节置换术的65岁以上老年患者年龄、性别、麻醉方式、术前合并症、是否输血、是否发生术后谵妄。用单因素和多因素Logistic回归方法,分析围术期相关因素和患者发生术后谵妄的关系。结果共有22例患者发生术后谵妄,发生率为13.6%。单因素分析表明年龄、体重、ASA分级、术前冠心病史、出血量、输血量、血钠浓度是术后发生谵妄的影响因素。其中年龄是术后发生谵妄的危险因素,年龄越大,发生谵妄的概率越大;体重、血钠浓度是术后发生谵妄的保护因素,体重越重、血钠浓度越高,发生谵妄的概率越低(P<0.05或0.01)。结论本研究基于年龄、体重、血钠浓度这3项老年全髋关节置换患者术后谵妄的独立影响因素,构建的预测老年全髋关节置换术后谵妄风险的列线图模型,具有良好的适用性,可为老年全髋关节置换术后谵妄评估提供科学指导。

Objective To establish a nomogram of delirium after total hip replacement in patients over 65 years old through analyzing the postoperative risk factors in elderly patients with total hip replacement.Methods From 2015 to 2016,data on age,gender,anesthesia mode,preoperative complications,blood transfusion and postoperative delirium of 208 elderly patients over 65 years old who underwent total hip replacement in the Department of Orthopaedics,Affiliated Hospital of Guangdong Medical University were retrospectively collected.The relationship between perioperative related factors and postoperative delirium was analyzed by univariate and multivariate Logistic regression.Results Postoperative delirium occurred in 22 patients,and incidence was 13.6%.Single factor analysis showed that age,weight,ASA grade,preoperative coronary heart disease history,bleeding volume,blood transfusion volume,blood sodium concentration were influencing factors of postoperative delirium.Age was the risk factor of postoperative delirium,the older the age,the greater the probability of delirium.Body weight and blood sodium concentration were protective factors for postoperative delirium,the heavier the body weight and the higher the blood sodium concentration,the lower the probability of delirium(P<0.05 or 0.01).Conclusion The nomogram predicting postoperative delirium in patients with total hip replacement based on three independent influencing factors-age,weight and concentration of serum sodium has good applicability,which can provide scientific guidance for the assessment of postoperative delirium in elderly patients.