[1]魏滨,张华①,徐懋,等.髋部骨折老年患者发生严重术后谵妄的多因素分析[J].中国微创外科杂志,2017,17(1):38-41.
　Wei Bin*,Zhang Hua,Xu Mao*,et al.A Multivariate Analysis of Risk Factors of Serious Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery[J].Chinese Journal of Minimally Invasive Surgery,2017,17(1):38-41.
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髋部骨折老年患者发生严重术后谵妄的多因素分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年1期
页码:
38-41
栏目:
临床论著
出版日期:
2017-04-18

文章信息/Info

Title:
A Multivariate Analysis of Risk Factors of Serious Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery
作者:
魏滨; 张华①; 徐懋; 李民; 王军; 张利萍; 郭向阳; 赵一鸣①; 周方②﹡
北京大学第三医院麻醉科，北京100083
Author(s):
Wei Bin*;  Zhang Hua;  Xu Mao*;  et al.
*Department of Anesthesiology, Peking University Third Hospital, Beijing 100083, China
关键词:
老年患者; 髋部骨折; 术后谵妄
Keywords:
Elderly patients; Hip fracture; Postoperative delirium
文献标志码:
A
摘要:
目的探讨髋部骨折老年患者发生严重术后谵妄的危险因素。方法回顾性分析我院骨科2005年1月～2014年12月572例髋部骨折老年患者接受内固定手术的临床资料，对性别、年龄、术前内科合并症、术前卧床时间、手术方式、麻醉方式、手术时间和术中出血量进行单因素分析，多因素logistic回归模型分析髋部骨折老年患者发生严重术后谵妄的危险因素。结果25例发生严重术后谵妄（25/572，发生率4.4%）。单因素分析结果显示年龄和麻醉方式有统计学差异（P＜0.05）；多因素logistic回归分析显示年龄（OR=1.12，95% CI：1.05～1.19，P=0.001）和全身麻醉（OR=5.03，95% CI：210～12.04，P=0.000）是髋部骨折老年患者发生严重术后谵妄的独立危险因素。结论年龄和全身麻醉是髋部骨折老年患者发生严重术后谵妄的独立危险因素。
Abstract:
ObjectiveTo investigate the risk factors of serious postoperative delirium after hip fracture surgery in elderly patients.MethodsA retrospective analysis was conducted according to the medical records of 572 elderly patients with hip fractures admitted to our hospital from January 2005 to December 2014. The age, gender, preoperative comorbidities, length of preoperative bedridden time, surgical types, anesthetic methods, operation time and blood loss were recorded. Multivariate logistic regression analysis was applied to analyze the risk factors of serious postoperative delirium after hip fracture surgery in elderly patients.ResultsOf the 572 patients, serious postoperative delirium occurred in 25 (25/572, 4.8%). Univariate analysis showed that the independent variables of serious postoperative delirium were age and anesthetic methods (P＜0.05). Multiple logistic regression analysis showed that age (odds ratio: 1.12, 95% CI: 1.05-1.19, P=0.001) and anesthetic methods (odds ratio: 5.02, 95% CI: 2.10-12.04, P=0.000) were risk factors for serious postoperative delirium after hip fracture surgery in elderly patients.ConclusionThe independent risk factors to serious postoperative delirium after hip fracture surgery in elderly patients include age and anesthetic methods.

参考文献/References:

[1]White SM, Griffiths R. Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury,2011,42(11):1230-1233.
[2]McDaniel M，Brudney C. Postoperative delirium: etiology and management. Curr Opin Crit Care,2012,18(4):372-376.
[3]Saczynski JS, Marcantonio ER, Quach L, et al. Cognitive trajectories after postoperative delirium. N Engl J Med,2012,367(1):30-39.
[4]Gunther ML, Morandi A, Ely EW. Pathophysiology of delirium in the intensive care unit. Crit Care Clin,2008,24(1):45-65.
[5]American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association, 2013.596.
[6]Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int,2004.15(11):897-902.
[7]Smith T, Hameed Y，Cross J, et al． Assessment of people with cognitive impairment and hip fracture: a systematic review and meta-analysis． Arch Gerontol Geriatr,2013,57(2):117-126.
[8]Rudolph JL, Marcantonio ER. Postoperative delirium: acute change with long-term implications. Anesth Analg,2011,112(5):1202-1211．
[9]Sethi S, Ghai B, Ram J, et al. Postoperative emergence delirium in pediatric patients undergoing cataract surgery-a comparison of desflurane and sevoflurane. Pediatric Anesthesia,2013,23(12):1131-1137.
[10]Wolters AE, Slooter AJC, Kooi AWVD, et al. Cognitive impairment after intensive care unit admission: a systematic review. European Journal of Intensive Care Med,2013,39(3):376-386.
[11]White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. Anaesthesia,2014,69(6):224-230.
[12]Lawrence VA, Hilsenbeck SG, Noveck H, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med,2002,162(18):2053-2057.
[13]Bickel H, Gradinger R, Kochs E, et al. Incidence and risk factors of delirium after hip surgery. Psychiatr Prax,2004,31(7):360-365.
[14]Watne LO， Torbergsen AC, Conroy S, et al. The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial(Oslo Orthogeriatric Trial). BMC Med,2014,12:63.
[15]Rashiq S，Vandermeer B，Abou-Setta AM，et al．Efficacy of supplemental peripheral nerve blockade for hip fracture surgery: multiple treatment comparison. Can J Anaesth,2013,60(3):230-243．
[16]Maldonado J. Pathoetiological model of delirium: a comprehensive understanding of the neurobiology of delirium and an evidence-based approach to prevention and treatment. Crit Care Clin,2008,24(4):789-856.
[17]Radtke FM，Franck M，Lorenz M，et al. Remifentanil reduces the incidence of post-operative delirium. J Int Med Ｒes,2010,38(4):1225-1232.
[18]Royse CF，Andrews DT，Newman SN，et al． The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery．Anaesthesia,2011,66(6):455-464.
[19]魏滨，张华，王军. 2种不同麻醉方法对髋部骨折老年患者术后肺部并发症发生的多因素分析.中国微创外科杂志,2015,15(4):289-292.
[20]Gleason OC. Delirium. Am Fam Physician,2003,67(5):1027-1034.
[21]Ashare RL, Falcone M, Lerman C. Cognitive function during nicotine withdrawal: Implications for nicotine dependence treatment. Neurophamacology,2014,76(1):581-591.
[22]Culp KR, Cacchione PZ. Nutritional status and delirium in long-term care elderly individuals. Appl Nurs Res,2008,21(2):66-74.

备注/Memo

备注/Memo:
﹡通讯作者，E-mail：zhou.md@126.com①临床流行病学研究中心②骨科
更新日期/Last Update: 2017-04-18