老年髋关节置换患者术后认知功能障碍的现状调查及纵向发展轨迹分析

Status quo and longitudinal development trajectory analysis of cognitive dysfunction in elderly patients with hip replacement

目的调查老年髋关节置换术患者术后认知功能障碍(POCD)的现状和纵向发展轨迹,并分析患者POCD与术后髋关节功能恢复的关系。方法采用便利抽样法,选择2021年1月—2022年3月在郑州大学第一附属医院骨科行髋关节置换术的老年患者为研究对象,使用简易精神状态检查量表(MMSE)评估患者术后1周、第1个月、第2个月和第3个月4个时间点的认知功能,采用潜类别增长模型(LCGM)拟合术后POCD的纵向发展轨迹,并用方差分析比较不同认知功能类别患者术后3个月牛津髋关节功能量表(OHS)评分的差异。结果共307例老年髋关节置换患者完成全部随访与资料收集。术后4个时间患者POCD(MMSE<8分)的发生率分别为30.29%(93/307)、29.97%(92/307)、28.66%(88/307)和21.17%(65/307),MMSE得分在术后1周时最低。采用LCGM识别出3个潜在类别认知功能纵向发展轨迹:无认知功能障碍208例(67.75%)、认知功能障碍改善32例(10.42%)、认知功能障碍持续67例(21.82%)。术后3个月,无认知功能障碍类别患者OHS评分最低,认知功能障碍持续类别患者OHS评分最高,3种认知功能纵向潜在类别患者的OHS评分差异有统计学意义(P<0.05)。结论老年髋关节置换患者POCD发生率在术后不同时间存在一定差异,以术后1周最明显;医护人员须动态评估老年患者的术后认知功能,对不同类型认知功能障碍采取针对性护理策略,以促进患者髋关节功能恢复。

Objective To investigate the current status and longitudinal development trajectory of postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip replacement surgery and analyze the relationship between POCD and postoperative hip joint function recovery.Methods Using the convenient sampling method,elderly patients who underwent hip replacement surgery in Department of Orthopedics in the First Affiliated Hospital of Zhengzhou University from January 2021 to March 2022 were selected as the research objects.The cognitive function at 1 week,1 month,2 months and 3 months after surgery was assessed using Mini-Mental State Examination(MMSE),and the longitudinal development trajectory of postoperative POCD was fitted using latent class growth model(LCGM).The differences between cognitive function categories and Oxford Hip Score(OHS)score at 3 months after surgery were compared by ANOVA.Results A total of 307 elderly patients with hip replacement completed full follow-up and data collection.The incidence of POCD(MMSE<8 points)in patients at four postoperative time points was 30.29%(93/307),29.97%(92/307),28.66%(88/307)and 21.17%(65/307),respectively.The MMSE score was lowest at 1 week after surgery.Three potential categories of cognitive function longitudinal development tracks were identified by LCGM,including 208 cases(67.75%)with no cognitive dysfunction,32 cases(10.42%)with improved cognitive dysfunction,and 67 cases(21.82%)with continuous cognitive dysfunction.Three months after surgery,patients with no cognitive impairment had the lowest OHS score,while patients with persistent cognitive impairment had the highest OHS score.There were statistically significant differences in OHS scores among patients with three longitudinal potential categories of cognitive function(P<0.05).Conclusions The incidence of POCD in elderly patients with hip replacement varies at different postoperative times,with the most significant difference occurring at 1 week after surgery.Medical staff must dynamically evaluate the postoperative cognitive function of elderly patients and adopt targeted nursing strategies for different types of cognitive impairments,to promote the patient's recovery of hip function.