摘要
目的研究老年髋部骨折患者手术后谵妄症状的发生率、临床特点和相关危险因素。方法91例60岁以上老年髋部骨折手术患者，用美国精神障碍诊断和统计手册第4版（DSMIV）谵妄标准进行诊断，术前、术后第1、3、5、8天和第12天，对患者进行精神错乱评估方法（confusion assessment methods，CAM）和简易智力状态检查量表（mini—mental state examination，MMSE）检查。有7项因素被选作谵妄的危险因素予以分析：患者〉75岁、术前认知功能受损（MMSE：文盲组17分、小学组20分、初中组24分）、并存疾病多（Charlson并存症指数≥4）、术后红细胞比积低（〈30％）、脱水、电解质明显紊乱（钠、钾和葡萄糖）、静脉使用吗啡泵。结果32例（34．1％）患者在手术后6d内发生谵妄，其中活动过度型（hyperactive）17例（53．1％），活动减退型（hypoactive）6例（18．8％），混合型9例（28．1％）。单因素分析具有统计学显著性的因素有年龄〉75岁[比值比（oddsratio，OR）=3．80，95％CI 1．38～10．533、术前认知功能受损（OR=3．08，95％CI1．24～8．15）、术后严重贫血（0R=2．75，95％CI 1．02～7．44）；多因素回归分析得到具有统计学意义的相关因素有年龄〉75岁[相对危险度（relativerisk，RR）=3．53，P=0．021]、术前认知功能受损（RR=2．98，P=0．047）。结论老年髋部骨折患者手术后谵妄发生率较高，采用CAM和MMSE量表辅助诊断和观察，能提高诊断率，年龄〉75岁、术前认知功能受损是发生手术后谵妄的危险因素。
Objective To investigate the incidence and manifestation of postoperative delirium and identify its possible risk factors in elderly hip surgery patients. Methods Ninety-one consecutive patients, aged 60 years and over, who underwent hip surgery because of hip fracture were enrolled in the study. The delirium was diagnosed by DSM-Ⅳ criteria. Patients were assessed preoperatively and on postoperate days 1,3,5,8 using the Confusion Assessment Method （CAM） and the Mini-mental State Examination（MMSE： the illiterate≤17, educated of grade school ≤20, educated of junior high school≤24）. Possible risk factors for delirium including older age （age〉 75 yrs）, preoperative cognitive impairment （MMSE≤24）, high medical comorbidity （Charlson comorbidity index≥ 4）, lower postoperative hematocrit （〈 30%）, dehydration, markedly abnormal serum electrolyte values （sodium, potassium, or glucose） and intravenous morphine pump in the post- operative period were analyzed by means of Chi-square test and logistic regression analysis. Results Postoperative delirium was detected in 32 （34.1%） patients during the first 6 days after surgery. Among these delirious patients, 17 （53. 1%） cases had a hyperactive type of delirium, 6 （18.8% ）cases developed a hypoactive delirium, and 9 （28.1%）cases had a mixed type. Univariate analysis showed that the older age （odds ratio（OR） = 3.80, 95 % CI 1.38-10. 533, preoperative cognitive impairment （OR = 3.08, 95 % CI 1.24-8.15 ）, lower postoperative hematocrit （OR = 2.75, 95 % CI 1.02-7.44 ） were risk factors （P〈 0.05）. According to multivariate analysis, significant risk factors for the development of delirium were older age （relative risk（RR）= 3.53, P= 0. 0213, preoperative cognitive impairment（RR = 2.98,P=0. 047）. Conclusions The incidence of delirium of hip surgery patients is high. Use of measurements such as the CAM and MMSE for delirium can enhance the detection of delirium. Risk factors like old age, low cognitive impairment are associated with postoperative delirium in hip surgery patients.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2008年第2期99-102,共4页
Chinese Journal of Geriatrics
