老年髋部骨折患者术后谵妄的风险因素分析

发布时间：2018-07-05 11:59

本文选题：高龄 + 术后谵妄　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:术后谵妄是老年髋部骨折术后最常见的并发症之一,严重影响患者的生活质量和生命健康,给社会造成了巨大的经济负担。本研究通过探究老年髋部骨折患者术后谵妄的风险因素,明确术后谵妄的高危人群,进而有针对性地预防谵妄,以达到减少谵妄发生率,促进患者早日康复,减轻社会负担。方法:纳入2015年2月至2016年8月期间,在吉林大学中日联谊医院骨科收治的老年髋部骨折患者240例。术前1天及术后1、2、3天密切观察患者,收集患者的一般资料,包括年龄、身高、体重、麻醉方式、手术时间、既往心血管病史等。将患者随机分为两组,FTS组在专业医生及麻醉师的指导下,患者术前2h给予不含酒精,含少许糖的透明液体,如茶、清水、咖啡等,术前6h给予易消化食物,术前8h可正常进食。传统组患者,术前常规禁食12h,禁饮4h。其他围手术期措施相同。所有患者均与术前1d由同一研究者采用简易精神状态量表检查、评估患者有无老年痴呆,认知功能损害的存在。对于谵妄的诊断,需分为两个步骤:先采用镇静深度量表(RASS),评估患者的镇静深度;再使用重症监护谵妄评估方法(CAM-ICU)评估谵妄。计算患者的体质指数(body mass index,BMI),参照WHO亚洲人BMI分级标准,将BMI分5个等级,分别赋值,并输入数据库。将患者的年龄、身高、体重、BMI、等待手术时间、手术时间等进行单因素分析,组间计量资料采用t检验,以α=0.05为标准,P0.05为差异具有统计学意义。最后将单因素分析证实差异有统计学意义的自变量,带入Logistic回归模型进行多因素分析。结果:1、FTS组术后谵妄的发病率为6.67%,而传统组发生率为20.83%,FTS组谵妄发生率明显小于传统组。结果显示:禁食禁饮在POD的发生率上差异有显著统计学意义(p0.05)。2、传统组POD组与非POD组进行单因素分析显示两组间年龄(x2=12.019,P0.05)、饮酒(x2=19.407,P0.05)、待术时间(x2=20.454,P0.05)、糖尿病(x2=24.569,P0.05)、BMI(t=2.107,P0.05)、手术时间(t=-6.516,P0.05)比较差异有统计学意义。多因素Logistic回归分析表明:年龄70~80岁组和年龄80岁组发生POD的风险分别是年龄70岁的7.720倍和8.339倍(95%CI分别为1.174~50.762和1.036~67.140);BMI偏瘦组患者发生POD的风险是BMI正常组患者的13.791倍(95%CI 1.359~139.979);饮酒≥3次/周的患者发生POD的风险是饮酒3次/周患者的7.120倍(95%CI 1.299~39.015);糖尿病组患者发生POD的风险是无糖尿病患者的9.180倍(95%CI 1.810~46.545);手术时间≥180min组患者发生POD的风险是手术180min组患者的11.559倍(95%CI1.741~76.728);等待手术时间≥7d的患者发生POD风险是待术时间1~7d组的14.943倍(95%CI 2.646~84.384)。结论:1、本研究证实了:尽可能缩短术前禁食禁饮时间可以降低谵妄发生率,有利于患者术后恢复,缩短住院时间。2、本研究证实:高龄、偏瘦、糖尿病、饮酒、手术时间、待术时间是术后谵妄的独立危险因素。各因素对预测术后谵妄均有一定的价值,预测准确性大小依次为:手术时间糖尿病饮酒年龄BMI待术时间。3、本研究证实:麻醉方式、吸烟与术后谵妄并无显著相关性。
[Abstract]:Objective: postoperative delirium is one of the most common complications after hip fracture in the elderly, which seriously affects the quality of life and life and health of the patients. The risk factors for postoperative delirium in the elderly hip fracture patients are explored, and the high-risk population of postoperative delirium is clearly defined and then targeted prevention is made. Delirium was used to reduce the incidence of delirium, promote early recovery and reduce social burden. Methods: from February 2015 to August 2016, 240 patients with hip fractures in the Department of orthopedics, China Japan Friendship Hospital, Jilin University, were admitted to the Department of orthopedics at the Jilin University China Japan Friendship Hospital. The patients were closely observed and collected at 1 days before and after the operation, and the general data of the patients were collected, including age and height. The patients were divided into two groups randomly. The patients were divided into two groups randomly. Under the guidance of professional doctors and anesthesiologists, group FTS was given a transparent liquid containing a few sugar, such as tea, water, coffee, and so on before operation 2H. Before operation, 6h was given to digestible food, and before the operation, 8h could be eaten normally. The other perioperative measures for 12h and 4h. were the same. All patients with preoperative 1D were examined by the same researcher with a simple mental state scale to assess the presence of dementia and cognitive impairment. The diagnosis of delirium should be divided into two steps: using a sedative depth scale (RASS) to assess the sedative depth of the patient. The CAM-ICU (body mass index, BMI) was used to evaluate the patient's body mass index (BMI). According to the WHO Asians' BMI grading standard, BMI was divided into 5 grades, assigned respectively, and entered the database. The patient's age, height, weight, BMI, waiting for operation time, and operation time were analyzed by single factor analysis. The data were measured with t test, with alpha =0.05 as the standard, P0.05 was statistically significant. Finally, a single factor analysis was used to confirm the statistically significant independent variables and into the Logistic regression model for multiple factors analysis. Results: 1, the incidence of postoperative delirium in group FTS was 6.67%, while the incidence of traditional group was 20.83%, and the incidence of delirium in group FTS was clear. The results showed that the difference in the incidence of POD was statistically significant (P0.05).2. The single factor analysis of the traditional group POD group and non POD group showed the age of two groups (x2=12.019, P0.05), drinking (x2=19.407, P0.05), the operation time (x2=20.454, P0.05), diabetes mellitus (x2=24.569,), surgery Time (t=-6.516, P0.05) was statistically significant. Multiple factor Logistic regression analysis showed that the risk of POD in age 70~80 and age 80 year group was 7.720 times and 8.339 times of age 70 (95%CI respectively 1.174~50.762 and 1.036~67.140), and the risk of POD in patients with BMI thinner group was 13.791 times (95). %CI 1.359~139.979); the risk of POD was 7.120 times as high as 3 times per week for patients who drank more than 3 times / week (95%CI 1.299~39.015); the risk of POD in the diabetic group was 9.180 times (95%CI 1.810~46.545) without diabetes; the risk of POD in patients with surgery longer than 180min was 11.559 times the 180min group (95%CI1.) (95%CI1.). 741~76.728); the risk of POD in patients waiting for more than 7d was 14.943 times as high as that of group 1~7d (95%CI 2.646~84.384). Conclusion: 1. This study confirmed that the reduction of delirium by reducing the time of pre operation prohibition and drinking can reduce the incidence of delirium, which is beneficial to postoperative recovery and shorten the duration of hospitalization. This study confirms that age, lean, diabetes, Alcohol, operation time and time were independent risk factors for postoperative delirium. All factors had certain value in predicting postoperative delirium, and the accuracy of prediction was in the order of operation time of diabetes drinking age of BMI for.3. This study confirmed that there was no significant correlation between smoking and postoperative delirium.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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