摘要
目的探究老年患者骨科手术后高活动型谵妄(postoperative delirium of high activity,PDHA)的发生率及危险因素。方法选择2009年3月—2017年8月于解放军第94医院行骨科手术的老年患者,根据术后是否发生PDHA将其分为PDHA组(n=47)和非PDHA组(n=182)。收集2组患者一般资料(年龄、性别比例、疾病类型),术前指标(贫血、痴呆、血糖异常、电解质异常、白蛋白异常及苯二氮卓类药物使用情况),手术情况(手术部位、麻醉方式、手术时长、术中低血压、苯二氮卓类及抗胆碱能药物使用情况)和术后情况(低血压、贫血、电解质异常及白蛋白异常情况),计算老年患者骨科术后发生PDHA的几率及各指标与PDHA的相关性。结果 PDHA组年龄≥80岁、髋部手术、术前贫血、术前痴呆、术中低血压、术后贫血患者比例均大于非PDHA组;多因素Logistic回归分析年龄≥80岁、髋部手术及术前贫血是老年患者骨科术后发生PDHA的独立危险因素(P<0.05)。结论年龄≥80岁、髋部手术及术前贫血是老年患者骨科术后发生PDHA的独立危险因素。
Objective To investigate the incidence of and risk factors for postoperative delirium of high activity(PDHA)in elderly patients undergoing orthopedic surgery.Methods Elderly patients who underwent orthopaedic surgery in our hospital between March 2009 and August 2017 and met the exclusion criteria(exclusion)were selected and divided into two groups:PDHA group(n=47)and non-PDHA group(n=182),according to the occurrence of PDHA.Then,related data was collected to analyze the incidence of and risk factors for PDHA,including the general data(age,gender ratio,disease type),preoperative indicators(anemia,dementia,abnormal blood glucose,electrolyte abnormalities,albumin abnormalities,and the use of benzodiazepines)and surgical conditions(the surgical site,anesthetic method,duration of surgery,intraoperative hypotension,and use of benzodiazepines and anticholinergic drugs),postoperative conditions(hypotension,anemia,electrolyte abnormalities and abnormal albumin).Results The proportion of patients aged 80 or above and with hip surgery,preoperative anemia,preoperative dementia,intraoperative hypotension and postoperative anemia in PDHA group was significantly higher than that in non-PDHA group.Logistic regression analysis showed that age(≥80 years),hip surgery and preoperative anemia were independent risk factors for PDHA in elderly patients after orthopaedic surgery(P<0.05).Conclusion Age≥80 years old,hip surgery and preoperative anemia are independent risk factors for PDHA after orthopedic surgery in elderly patients.
作者
刘建明
LIU Jianming(Department of Anesthesiology, The 94th Hospital of PLA, Nanchang 330000, China)
出处
《空军医学杂志》
2018年第6期395-397,404,共4页
Medical Journal of Air Force
