Muangpaisan Weerasak, Wongprikron Asita, Srinonprasert Varalak, Suwanpatoomlerd Sarawut, Sutipornpalangkul Werasak, Assantchai Prasert
J Med Assoc Thai. 2015 Apr;98(4):423-30.
To determine the incidence and associated factors of delirium in older patients admitted with hip fracture.
Eighty patients with fall-related hip fracture who admitted to orthopedics wards in Siriraj Hospital were recruited. Baseline characteristics, functional ability and cognitive status, treatment-related factors, clinical outcomes, length of stay, and direct medical cost were evaluated. Delirium was diagnosed by experienced geriatricians using DSM-IV RESULTS: Thirty-six patients (45%,) developed delirium. Hyperactive and hypoactive delirium was 24:12 patients. Preoperative and postoperative delirium was developed in 18:18 patients. Age, TMSE score on admission, modified IQCODE score, premorbid mRS, receiving NSAIDs around the clock postoperatively, and sedative drug use were significantly different between the non-delirium and delirium groups in multivariate logistic regression analysis. Patients with delirium did not have significantly higher postoperative complications, hospital length ofstay, functional status (mRS) at discharge, mortality, and direct cost of the treatment in hospital.
Delirium is common in elderly hip fracture undergoing hip repair. Age, premorbid function, dementia/cognitive impairment, NSAIDs, and sedative use were associated factors of delirium. Identifying those with high-risk factors should be routinely performed rigorously and strategies to reduce delirium incidence and severity should be planned and conducted.
确定髋部骨折老年住院患者谵妄的发生率及相关因素。
招募了80例因跌倒导致髋部骨折并入住诗里拉吉医院骨科病房的患者。评估了患者的基线特征、功能能力和认知状态、治疗相关因素、临床结局、住院时间和直接医疗费用。由经验丰富的老年病科医生依据《精神疾病诊断与统计手册》第四版（DSM-IV）诊断谵妄。结果：36例患者（45%）发生谵妄。其中激越型和安静型谵妄患者分别为24例和12例。术前和术后发生谵妄的患者各18例。多因素逻辑回归分析显示，非谵妄组和谵妄组在年龄、入院时的简易精神状态检查表（TMSE）评分、改良智力衰退检查表（IQCODE）评分、病前改良Rankin量表（mRS）评分、术后持续使用非甾体抗炎药（NSAIDs）以及使用镇静药物方面存在显著差异。谵妄患者在术后并发症、住院时间、出院时的功能状态（mRS）、死亡率和住院直接治疗费用方面并无显著升高。
谵妄在接受髋部修复手术的老年髋部骨折患者中较为常见。年龄、病前功能、痴呆/认知障碍、NSAIDs使用和镇静药物使用是谵妄的相关因素。应常规且严格地识别那些具有高危因素的患者，并制定和实施降低谵妄发生率和严重程度的策略。
