摘要
背景：老年髋部周围骨折患者围手术期易出现各种并发症，其中围手术期精神障碍（perioperative delirium, POD）近年来逐渐得到国内骨科医师的重视。预防POD发生，是摆在骨科医生面前的重要问题。 目的：探讨老年髋部周围骨折患者中POD的发病率,以及其发病相关的危险因素和保护因素。 方法：回顾性分析2001年1月至2013年1月收治的384例老年髋部周围骨折行大型手术的患者，女206例，男178例；年龄65-95岁，平均78.3岁。以性别、年龄、手术时间、手术方式、麻醉方式、输血、药物治疗及合并症为自变量，POD的发病率为因变量，进行Logistic回归分析。 结果：384例患者平均住院时间15.8 d（7-35 d），其中79例发生POD，发生率为20.6%。经分析进入Logistic回归方程的因素是年龄、手术时间、麻醉方式、合并症、输血、药物治疗（P〈0.05）。其中高龄、手术时间过长、全身麻醉、合并症（尤其脑血管病变）是POD的危险因素，输血和药物治疗是保护因素。性别及手术方式对发生POD的影响差异无统计学意义（P〉0.05）。 结论：老年髋部周围骨折易并发POD。围手术期仔细评估POD形成的相关因素，避免全身麻醉和手术时间过长，积极治疗合并症。高危患者必要时应输血并采用药物预防以降低POD的发生率。
Background： Hip fractures in elderly patients prone to a variety of perioperative complications. Perioperative delirium （POD） has been paid more attention in recent years. Objective：To investigate the incidence, risk factors and protective factors of POD in the elderly with hip fracture. Methods：A retrospective analysis was performed in 384 elderly patients with hip fracture treated by surgery from January 2001 to January 2013. There were 206 females and 178 males with a mean age of 78.3 years （range, 65 to 95 years）. Gen-der, age, operative time, surgical approach, anesthesia, blood transfusion, medications and complications were taken as inde-pendent variables, and the incidence of POD was taken as dependent variable for Logistic regression analysis. Results：The mean hospital stay of the 384 patients was 15.8 days （range, 7 to 35 days）. POD occurred in 79 patients, and the incidence of POD was 20.6%. The age, operation time, anesthesia, complications, blood transfusion and medication were enrolled into Logistic regression equation （P〈0.05）. Advanced age, extremely-long operative time, general anesthesia, complications （cerebrovascular disease, especially） were risk factors for POD, while medications and blood transfusion were protective factors. Gender and surgical approach were not significantly related to POD （P〉0.05）. Conclusions：Elderly hip fractures are often complicated by POD. Orthopaedic surgeons should carefully evaluate periopera-tive factors related to POD, avoid general anesthesia, decrease surgical time, and actively manage complications. It is essen-tial to take transfusion and drug prophylaxis for high-risk patients.
出处
《中国骨与关节外科》
2014年第2期108-112,共5页
Chinese Journal of Bone and Joint Surgery
关键词
老年髋部骨折
围手术期
精神障碍
因素分析
Hip fracture,elderly
Perioperative period
Delirium
Factors analysis
