围术期谵妄对老年髋部骨折患者预后的影响

Influence of perioperative delirium on prognosis of hip fracture in elderly patients

目的探讨围术期谵妄(PED)对老年髋部骨折患者预后的影响。方法选择2017年4—10月在北京积水潭医院行手术治疗的老年髋部骨折患者219例,PED组31例,其中术前谵妄11例(术后缓解2例,未缓解9例),术后谵妄20例;非PED组188例(对照组)。比较2组患者的住院时间、住院期间转入重症监护病房比例和病死率;术前1 d和术后当天应用简易智力状态检查量表对患者进行认知功能评估;入院时根据患者及家属描述应用日常生活活动能力量表(ADL)评估患者骨折前生活能力,术后1周和1个月再次评估,判断患者的恢复情况;比较2组患者术后1周及1个月运动恢复效果,观察站立及行走情况。结果对照组住院时间短于PED组[(1. 8±0. 8) d比(2. 4±1. 0) d](P <0. 05)。术后谵妄组(20例)术后简易智力状态检查量表评分下降比例高于对照组[90. 0%(18/20)比35. 1%(66/188)](P <0. 001)。术后1周,2组患者ADL评分均低于骨折前,且PED组低于对照组[(23±13)分比(40±16)分](均P <0. 001)。术后1个月,2组患者ADL评分均高于术后1周,但仍低于骨折前,且PED组低于对照组[(44±20)分比(69±20)分](P <0. 001)。PED组术后1周可站立、行走比例以及术后1个月可行走比例均低于对照组(均P <0. 05)。结论 PED是术后不良预后的重要危险因素。

Objective To observe the influence of perioperative delirium( PED) on prognosis in elderly patients with hip fracture. Methods From April to October 2017,219 elderly patients with hip fracture who underwent surgical treatment in Beijing Jishuitan Hospital were included;31 patients had PED( PED group),among which 11 cases were preoperative delirium( 2 cases were relieved after surgery) and 20 cases were postoperative delirium;188 patients without PED were control group. Length of hospital stay,intensive care unit( ICU) transfer rate and mortality were recorded. Cognitive function was evaluated by Mini-Mental State Examination( MMSE) 1 d before and the same day after surgery. Living capacity before fracture was evaluated by Activities of Daily Living( ADL) according to patients or their relatives’ description on admission. ADL score and exercise recovery were assessed 1 week and 1 month after surgery. Results Length of hospital stay in the control group was shorter than that in the PED group[( 1. 8 ± 0. 8) d vs( 2. 4 ± 1. 0) d]( P < 0. 05). Postoperative MMSE score decreasing rate in postoperative delirium patients was higher than that in the control group[90. 0%( 18/20) vs 35. 1%( 66/188) ]( P <0. 001). One week after surgery,ADL score decreased in both groups and the score in the PED group was lower than that in the control group[( 23 ± 13) vs( 40 ± 16) ]( P < 0. 001). One month after surgery,ADL score was higher than that 1 week after surgery but still lower than that before fracture;the score in the PED group was lower than that in the control group[( 44 ± 20) vs( 69 ± 20) ]( P < 0. 001). Ratios of patients being able to stand or walk 1 week after surgery and walking ratio 1 month after surgery in the PED group were lower than those in the control group( P < 0. 05). Conclusion PED is an important prognostic risk factor in elderly patients with hip fracture.