Chen Wenliang, Ke Xiurong, Wang Xiaoqing, Sun Xiaoliang, Wang Juncheng, Yang Guojing, Xia Haijie, Zhang Lei
Department of adult reconstruction, the third affiliated hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325200, China.
Department of anesthesia, the third affiliated hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325200, China.
Gen Hosp Psychiatry. 2017 May;46:55-61. doi: 10.1016/j.genhosppsych.2017.03.008. Epub 2017 Mar 21.
The aim of this prospective study was to investigate the incidence and clinical features of delirium after total joint arthroplasty, and to establish the potential risk factors for postoperative delirium.
A total of 212 consecutive patients undergoing hip or knee arthroplasty, who met the inclusion and exclusive criteria were enrolled. The general characteristics, preoperative and postoperative hematological variables were documented respectively. According to the presence of delirium, all patients were divided into the delirium group and non-delirium group. Univariate and multivariate logistic regression were performed to identify the possible predictors for postoperative delirium.
At a minimum of 6months of follow-up, 35 patients were observed with postoperative delirium at an estimated total incidence of 16.5%. The incidence of delirium was statistically higher in hip arthroplasty (22.8%) than that in knee arthroplasty (7.1%). The multivariate regression analysis identified older age (OR=1.590, P=0.023), a history of stroke (OR=190.23, P=0.036), preoperative PaO (OR=1.277, P=0.018) and equivalent fentanyl dose (OR=1.010, P=0.012) as the predictive factors for postoperative delirium after total joint arthroplasty.
The incidence of postoperative delirium after total joint arthroplasty is higher than expected. Based on our findings, we suggest that the surgeons should focus on those patients who have these risk factors and ensure the appropriate management to avoid postoperative delirium.
这项前瞻性研究的目的是调查全关节置换术后谵妄的发生率和临床特征，并确定术后谵妄的潜在危险因素。
连续纳入212例接受髋或膝关节置换术且符合纳入和排除标准的患者。分别记录其一般特征、术前和术后血液学变量。根据是否发生谵妄，将所有患者分为谵妄组和非谵妄组。进行单因素和多因素逻辑回归分析以确定术后谵妄的可能预测因素。
在至少6个月的随访中，观察到35例患者发生术后谵妄，估计总发生率为16.5%。髋置换术患者谵妄发生率（22.8%）在统计学上高于膝置换术患者（7.1%）。多因素回归分析确定年龄较大（OR=1.590，P=0.023）、有中风病史（OR=190.23，P=0.036）、术前动脉血氧分压（OR=1.277，P=0.018）和等效芬太尼剂量（OR=1.010，P=0.012）为全关节置换术后谵妄的预测因素。
全关节置换术后谵妄的发生率高于预期。基于我们的研究结果，我们建议外科医生应关注有这些危险因素的患者，并确保进行适当管理以避免术后谵妄。
