Adunsky Abraham, Levy Rami, Heim Michael, Mizrahi Eliyahu, Arad M
Department of Orthopedic-Geriatric Medicine, Bitan 38, Sheba Medical Center, Tel Hashomer 52621, Israel.
Arch Gerontol Geriatr. 2002 Nov-Dec;35(3):253-9. doi: 10.1016/s0167-4943(02)00045-6.
Delirium is quite frequent in elderly patients who sustain hip fractures. The use of Meperidine by physicians, unaware of the possible emergence of delirium in elderly patients, is very popular. We have retrospectively examined the incidence of delirium in 181 consecutive patients admitted to the orthogeriatric ward with hip fractures. We used the confusion assessment method to establish the presence of delirium in all patients. A database search was conducted to identify which patients were treated by Meperidine, or Morphine, prior to delirium onset. We identified 92 cases, 44 of whom were treated by Meperidine alone, and the other 48 treated by Morphine alone. Delirium was diagnosed in 13 (27.1%) Morphine treated patients as compared with 19 (43.2%) treated by Meperidine (P<0.001). Age, cognitive status and opiate use were associated with perioperative delirium. A subset regression analysis showed that exposure to Meperidine was significantly associated with delirium (odds ratio 2.5, P<0.01), in contrast with Morphine. Our results confirm the association between exposure to Meperidine and delirium, suggesting that this drug should be withdrawn in elderly hip fractured patients undergoing surgery, and substituted by low dose Morphine analgesia. Reducing the incidence of delirium, by adopting such an approach, may result in a significant potential of savings in direct costs, related to treatment of delirium in this population.
谵妄在髋部骨折的老年患者中相当常见。医生使用哌替啶的情况很普遍，而他们并未意识到老年患者可能会出现谵妄。我们回顾性研究了181例连续入住老年骨科病房的髋部骨折患者的谵妄发生率。我们采用谵妄评估方法来确定所有患者是否存在谵妄。通过数据库搜索来确定哪些患者在谵妄发作前接受了哌替啶或吗啡治疗。我们确定了92例患者，其中44例仅接受哌替啶治疗，另外48例仅接受吗啡治疗。接受吗啡治疗的患者中有13例（27.1%）被诊断为谵妄，而接受哌替啶治疗的患者中有19例（43.2%）被诊断为谵妄（P<0.001）。年龄、认知状态和阿片类药物的使用与围手术期谵妄有关。亚组回归分析显示，与吗啡相比，使用哌替啶与谵妄显著相关（优势比2.5，P<0.01）。我们的结果证实了使用哌替啶与谵妄之间的关联，表明在接受手术的老年髋部骨折患者中应停用这种药物，并用低剂量吗啡镇痛替代。通过采取这种方法降低谵妄的发生率，可能会显著节省与该人群谵妄治疗相关的直接成本。
