ERAS在围手术期干预老年股骨转子间骨折患者围手术期谵妄发生率的效果分析

Effect Analysis of ERAS in Perioperative Intervention in the Incidence of Perioperative Delirium in Elderly Patients with Intertrochanteric Fracture

目的 探讨快速康复外科治疗(ERAS)的围手术期干预措施在老年股骨粗隆间骨折患者围手术期谵妄管理的效果,为临床治疗提高参考。方法 2019年1月1日-2021年12月31日某院300例转子间骨折接受PFNA内固定的患者,采用回顾性病例对照研究的方法,以患者是否实施ERAS围手术期干预措施、术中是否使用苯二氮卓类药物、术中失血、既往受教育程度等作为影响因素进行单因素和多因素分析患者围手术期谵妄的发生率。结果 单因素分析发现,是否实施快速康复、文化程度和术后贫血程度对谵妄发生差异有统计学意义,P<0.05,以老年髋部骨折患者围手术期是否发生谵妄为因变量,以单因素分析结果中有意义的变量为自变量,采用非条件Logistic回归方法进行多因素分析,结果显示老年髋部骨折患者实施ERAS发生谵妄的风险下降了79.6%。结论 通过对围手术期老年转子间骨折患者实施ERAS围手术期干预措施可以明显降低患者术后谵妄的发生率。

Objectives To investigate the effect of perioperative intervention of rapid rehabilitation surgery(ERAS)in the management of perioperative delirium in elderly patients with intertrochanteric fracture of femur,and improve the reference for clinical treatment.Methods A retrospective case-control study was conducted on 300 patients with intertrochanteric fracture who received PFNA internal fixation from January 1st,2019 to December 31st,2021 in a hospital.The incidence of perioperative delirium was analyzed by univariate and multivariate factors,including whether the patients implemented perioperative intervention under the guidance of the concept of rapid rehabilitation,whether benzodiazepines were used during the operation,intraoperative blood loss,and previous education level.Results Univariate analysis showed that ERAS,educational level and postoperative anemia degree had statistical significance in delirium(P<0.05).No statistically significant difference was found in other aspects(P>0.05).Using whether elderly patients with hip fractures experienced delirium during the perioperative period as the dependent variable and meaningful variables in the univariate analysis as independent variables,unconditional logistic regression was used for multivariate analysis.The results showed that the risk of delirium in elderly patients with hip fractures who underwent ERAS decreased by 79.6%(0R=0.204,95%CI:0.120~0.348).Conclusion The incidence of postoperative delirium in elderly patients with perioperative intertrochanteric fracture could be significantly reduced by implementing perioperative intervention under the guidance of ERAS concept.