分析中老年骨折患者围手术期术后谵妄的危险因素。
Analysis of risk factors for postoperative delirium in middle-aged and elderly fracture patients in the perioperative period.
机构信息
Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China.
The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China.
出版信息
Sci Rep. 2023 Aug 10;13(1):13019. doi: 10.1038/s41598-023-40090-z.
To investigate the incidence rate and risk factors of postoperative delirium in middle-aged and elderly patients with fracture. A total of 648 middle-aged and elderly fracture patients who underwent surgical treatment in our hospital from January 2018 to December 2020 were included in the study, aged 50-103 years, mean 70.10 ± 11.37 years. The incidence of postoperative delirium was analyzed. Univariate analysis was used to screen the risk factors of gender, age, interval between injury and operation, preoperative complications, fracture site, anesthesia method, operation time, intraoperative blood loss, hidden blood loss and hormone use. For the factors with P < 0.05, multivariate logistic regression analysis was used to determine the main independent risk factors. 115 cases (17.74%) of 648 patients had postoperative delirium. Univariate analysis showed that patients with delirium and patients without delirium had significant correlation in age, medical disease comorbidity, fracture type, anesthesia method, operation time and perioperative blood loss (P < 0.05). Multivariate logistic regression analysis showed that age (OR = 1.061), preoperative complications (OR = 1.667), perioperative blood loss (OR = 1.002) were positively correlated with postoperative delirium. It shows that older age, more preoperative complications, longer operation time and more perioperative bleeding are more likely to lead to postoperative delirium; patients with general anesthesia were more likely to develop postoperative delirium than patients with local anesthesia (OR = 1.628); and patients with hip and pelvic fractures are more likely to develop a postoperative delirious state (OR = 1.316). Advanced age, complex orthopedic surgery, more medical comorbidities, general anesthesia and greater perioperative blood loss may be independent risk factors for the development of delirium after internal fixation of fractures in middle-aged and elderly patients.
目的
调查中老年骨折患者术后谵妄的发生率及相关危险因素。
方法
选取我院 2018 年 1 月至 2020 年 12 月收治的 648 例行手术治疗的中老年骨折患者作为研究对象，年龄 50~103 岁，平均（70.10±11.37）岁。分析术后谵妄的发生率。采用单因素分析筛选性别、年龄、受伤至手术时间间隔、术前合并症、骨折部位、麻醉方式、手术时间、术中失血量、隐性失血量、激素使用等因素的危险因素。对 P<0.05 的因素进行多因素 logistic 回归分析，确定主要的独立危险因素。
结果
648 例患者中术后谵妄 115 例（17.74%）。单因素分析显示，谵妄组与非谵妄组患者的年龄、合并内科疾病、骨折类型、麻醉方式、手术时间、围术期出血量比较差异有统计学意义（P<0.05）。多因素 logistic 回归分析显示，年龄（OR=1.061）、术前合并症（OR=1.667）、围术期出血量（OR=1.002）与术后谵妄呈正相关。结果表明，年龄越大、术前合并症越多、手术时间越长、围术期出血量越大，越容易导致术后谵妄；全麻患者比局部麻醉患者更易发生术后谵妄（OR=1.628）；髋部和骨盆骨折患者更易发生术后谵妄状态（OR=1.316）。高龄、复杂骨科手术、合并更多内科疾病、全麻和更大的围术期出血量可能是中老年患者骨折内固定术后发生谵妄的独立危险因素。
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