不同营养状况的全麻下行防旋型股骨近端髓内钉手术老年病人术后谵妄发生情况及影响因素分析

Analysis of the incidence and influencing factors of postoperative delirium in elderly patients with different nutritional status undergoing proximal femoral nail antirotation under general anesthesia

目的旨在明确不同营养状况的老年病人进行防旋型股骨近端髓内钉(PFNA)内固定术后谵妄发生情况及影响因素,为实施针对性的干预提供依据。方法选取于南京鼓楼医院集团宿迁医院在全身麻醉下行PFNA手术的老年病人335例为研究对象,术前1 d使用微型营养评定法简表(MNA-SF)评定病人的营养状况,术后使用意识模糊评估量表(CAM)评定病人是否发生术后谵妄。对病人术后发生谵妄的影响因素分别进行单因素分析与多因素Logistic回归分析。结果183例营养状况正常老年病人中,48例(26.23%)病人术后发生谵妄;152例MNA-SF评分为0~11分的老年病人中,63例(41.45%)病人术后发生了谵妄,差异有统计学意义(P<0.05)。MNA-SF评分为0~7分的病人术后谵妄发生率为60.78%(31/51),显著高于评分为8~11分的病人[31.68%(32/101),P<0.05]。多因素Logistic回归分析显示,年龄≥75岁、BMI<20、合并营养不良、低蛋白血症、全麻时间≥120 min、术后镇痛效果不佳及MMSE评分<27分等是PFNA老年病人术后谵妄发生的危险因素。结论合并营养不良风险或营养不良的PFNA手术老年病人术后谵妄发生率较高,营养状况越差的病人,越容易发生术后谵妄。

Objective To explore the incidence and risk factors of postoperative delirium(POD)in the elderly patients with different nutritional status who received proximal femoral nail antirotation(PFNA)internal fixation,and to provide basis for targeted intervention.Methods A total of 335 elderly patients were selected from Suqian Hospital of Nanjing Drum Tower Hospital Group who received PFNA internal fixation under general anesthesia.Mini Nutritional Assessment Short-form(MNA-SF)was used to assess the nutritional status before operation,and Confusion Assessment Method(CAM)was used to assess the incidence of POD.Multiple Logistic regression analysis was performed to analyze the influencing factors of the occurrence of POD.Results The incidence rate of POD was 26.23%(48/183)in the elderly patients with normal nutrition,compared with 41.45%(63/152)in those with MNA-SF score of 0-11(P<0.05).The incidence rate of POD in the elderly patients with MNA-SF score of 0-7 was significantly higher than that in the patients with score of 8-11(60.78%vs 31.68%,P<0.05).Multivariate Logistic regression analysis showed that age≥75 years,body mass index<20,malnutrition,hypoalbuminemia,general anesthesia time≥120 min,poor postoperative analgesia effect and MMSE score<27 were the risk factors for POD in the elderly patients receiving PFNA internal fixation.Conclusions The incidence rate of POD in the elderly patients undergoing PFNA surgery with malnutrition risk or malnutrition is higher.The patients with poorer nutritional status are more likely to have POD.