老年股骨粗隆间骨折患者术后谵妄发生情况及相关因素分析

The incidence of postoperative delirium in elderly patients with intertrochanteric fracture and its related foctors

目的分析老年股骨粗隆间骨折患者术后谵妄发生情况及相关因素,为临床预防术后谵妄提供参考依据。方法92例老年股骨粗隆间骨折患者均行闭合复位PFNA治疗,观察患者术后谵妄发生情况,并根据术后是否发生谵妄将患者分为谵妄组与非谵妄组;收集2组患者的一般资料,整理临床资料,对比其差异性,再运用多因素Logistic回归分析法分析术后发生谵妄的相关因素。结果92例患者中,术后发生谵妄19例(20.65%);谵妄组与非谵妄组的年龄、手术时长、ASA分级、术后使用镇痛泵、术后疼痛评分、术后认知功能评分、围手术期失血量、合并基础疾病比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析,结果显示,年龄、手术时长、ASA分级、术后疼痛评分、术后认知功能评分、围手术期失血量、合并基础疾病是危险因素(P<0.05),术后使用镇痛泵是保护因素(P<0.05)。结论老年股骨粗隆间骨折患者术后谵妄的发生率较高,影响因素较多,应实施相应的预防处理措施以消除相关因素,以降低术后谵妄发生率,继而提高手术治疗效果。

Objective To investigate the incidence of postoperative delirium in elderly patients with intertrochanteric fracture and its related foctors,so as to provide reference for clinical prevention of postoperative delirium.Methods A total of 92 elderly patients with intertrochanteric fracture who were treated by closed reduction PFNA in our hospital from January 2016 to October 2020 were enrolled in the study,who were divided into delirium group and non delirium group.The general data,and incidence of postoperative delirium were observed and compared between the two groups.Moreover the related factors with postoperative delirium were analyzed by multivariate Logistic regression analysis.Results Of the 92 patients,19 cases had postoperative delirium,with the incidence rate being 20.65%.There were significant differences in patient’s age,operation duration,ASA classification,postoperative analgesia pump,postoperative pain score,postoperative cognitive function score,perioperative blood loss and combined basic diseases between the two groups(P<0.05).Multivariate logistic regression analysis showed that age,operation time,ASA grade,postoperative pain score,postoperative cognitive function score,perioperative blood loss,combined with basic diseases were risk factors,however,postoperative analgesia pump was a protective factor.Conclusion The incidence of postoperative delirium in elderly patients with intertrochanteric fracture is higher,with many influencing factors,therefor,it is necessary to take corresponding preventive measures to eliminate the related factors,so as to reduce the incidence of postoperative delirium and improve the effects of surgical treatment.