老年髋部骨折病人术后发生谵妄危险因素的Meta分析

Risk factors for postoperative delirium in elderly patients with hip fracture:a Meta-analysis

目的:系统评价老年髋部骨折病人术后发生谵妄的危险因素。方法:检索中外文数据库建库至2020年9月1日纳入的关于老年髋部骨折病人术后谵妄危险因素文献。由2名研究者独立进行文献筛选、质量评价和资料提取,采用RevMan 5.3进行Meta分析。结果:共纳入31篇文献,共9143例病人,经Meta分析显示,高龄[OR=1.11,95%CI(1.09,1.13),P<0.00001]、合并基础疾病[OR=3.42,95%CI(2.37,4.96),P<0.00001]、术前认知功能障碍[OR=4.10,95%CI(3.33,5.06),P<0.00001]、低白蛋白[OR=0.91,95%CI(0.87,0.95),P<0.0001]、低氧血症[OR=4.53,95%CI(2.24,9.14),P<0.0001]、疼痛[OR=1.90,95%CI(1.49,2.42),P<0.00001]、夜间平均睡眠时间少[OR=4.13,95%CI(3.92,4.35),P<0.00001]、入院至手术间隔时间长[OR=5.44,95%CI(3.68,8.02),P<0.00001]、全身麻醉[OR=3.48,95%CI(2.57,4.71),P<0.00001]、手术时长[OR=1.07,95%CI(1.02,1.13),P=0.01]、术中失血量多[OR=3.63,95%CI(2.44,5.41),P<0.00001]和美国麻醉师协会(ASA)评分高[OR=4.14,95%CI(2.60,6.57),P<0.00001]均是老年髋部骨折病人术后发生谵妄的危险因素。结论:现有证据表明,高龄、合并基础疾病、术前认知障碍、低白蛋白、低氧血症、疼痛、夜间平均睡眠时间少、入院至手术间隔时间长、麻醉方式、手术时长、术中失血量多、ASA评分高等是老年髋部骨折病人术后发生谵妄的危险因素。受研究样本量和质量的影响,尚需开展更多高质量的研究进行验证。

Objective:To systematically evaluate the risk factors of postoperative delirium in elderly patients with hip fracture.Methods:Literatures on the risk factors of postoperative delirium in elderly patients with hip fracture from the establishment of Chinese and foreign database to September 1,2020 were searched.Literature screening,quality evaluation and data extraction were carried out independently by two researchers,and RevMan 5.3 was used for Meta-analysis.Results:A total of 31 papers were included,involving 9143 patients.Meta-analysis results showed that,old age[OR=1.11,95%CI(1.09,1.13),P<0.00001],complicated with basic diseases[OR=3.42,95%CI(2.37,4.96),P<0.00001],preoperative cognitive impairment[OR=4.10,95%CI(3.33,5.06),P<0.00001],hypoalbumin[OR=0.91,95%CI(0.87,0.95),P<0.0001],hypoxemia[OR=4.53,95%CI(2.24,9.14),P<0.0001],pain[OR=1.90,95%CI(1.49,2.42),P<0.00001],less average sleep time at night[OR=4.13,95%CI(3.92,4.35),P<0.00001],long interval between admission and operation[OR=5.44,95%CI(3.68,8.02),P<0.00001],anesthesia mode[OR=3.48,95%CI(2.57,4.71),P<0.00001],long operation time[OR=1.07,95%CI(1.02,1.13),P=0.01],large intraoperative blood loss[OR=3.63,95%CI(2.44,5.41),P<0.00001]and high ASA score[OR=4.14,95%CI(2.60,6.57),P<0.00001]were the risk factors of postoperative delirium in elderly patients with hip fracture.Conclusion:Current evidences showed that old age,complicated with basic diseases,preoperative cognitive impairment,hypoalbumin,hypoxemia,pain,less average sleep time at night,long interval between admission and operation,anesthesia mode,long operation time,large intraoperative blood loss and high ASA score were the risk factors of postoperative delirium in elderly patients with hip fracture.Affected by the sample size and quality of the study,more high-quality studies need to be carried out for verification.