老年髋部骨折患者术后谵妄危险因素的相关性分析
发布时间：2018-07-23 20:16
【摘要】：目的:谵妄又称急性脑综合征,主要表现为意识障碍、行为无章、注意力无法集中、认知功能下降、觉醒度改变、感知觉异常、日夜颠倒等,通常起病急,病情波动明显,常见于老年人。早在2000年前,希波克拉底即将谵妄描述为急性的精神混乱状态和明显的认知功能与注意力的全面损害。但时至今日,谵妄的危险因素尚不完全明确、发病机制亦不清楚、预防及治疗措施因较多的副反应而并未得到广泛应用,且老年髋部骨折谵妄发病率高、危害大,因此设计本实验以探讨老年髋部骨折患者术后发生谵妄的危险因素,并评估RD谵妄风险评分表用于国人髋部骨折谵妄风险评估的有效性,为临床预防谵妄的发生提供理论指导。方法:收集西南医科大学附属医院2014年9月至2016年12月髋部骨折并接受手术治疗的患者239例,年龄60-100岁,平均74.0岁,其中男105例,女134例;股骨颈骨折129例,转子间骨折110例;全髋关节置换术(Total Hip Arthroplasty,THA)82例,人工股骨头置换术41例,空心螺钉内固定术6例,股骨近端防旋转螺钉内固定术(Proximal Femoral Nail Antirotation,PFNA)110例;入院即以意识错乱评估方法(The Confusion Assessment Method,CAM)评估并排除已处于谵妄状态的患者;以简易精神评估量表(The Minimum Mental State Examination,MMSE)评估患者的基础认知功能情况;以RD谵妄风险评分表(The Risk Model For Delirium,RD)评估患者发生谵妄的风险大小;入院后除手术日外,每日早晨及下午以CAM评估患者是否处于谵妄状态,及时排除术前出现谵妄的患者;收集非谵妄状态患者的骨折部位、手术方式、年龄、性别、入院至结束观察期间夜间睡眠时间的平均值(夜间平均睡眠时间)、受伤至手术的间隔时间(间隔时间)、心脏射血分数、入院后第一次抽血化验的肝肾功能结果,如谷丙转氨酶(Alanine Aminotransferase,ALT)、谷草转氨酶(Aspartate Transaminase,AST)、肌酐(Creatinine,Cr)、胱抑素C(Cystatin C,CYC)、肾小球滤过率(Glomerular Filtration Rate,GFR),高血压及糖尿病病史、麻醉方式、麻醉时间、术中失血量以及RD评分等资料并进行卡方检验,将卡方检验结果中P≤0.1的因素行非条件Logistic回归统计学分析;结果:1.对上述资料以卡方检验分析,结果提示年龄、手术方式、受伤至手术的间隔时间、夜间平均睡眠时间、射血分数、麻醉方式、麻醉时间、术中失血量及RD评分为老年患者髋部骨折术后谵妄的影响因素;2.非条件Logistic回归分析结果显示年龄≥75岁的患者发生谵妄风险是75岁患者的7.672倍;受伤至手术的间隔时间3天的患者发生谵妄的风险是≤3天患者的7.820倍;夜间平均睡眠时间≤5h的患者发生谵妄的风险是5h患者的4.132倍;麻醉方式为全身麻醉的患者发生谵妄风险是蛛网膜下腔麻醉患者的4.804倍;麻醉时间≥120min的患者发生谵妄风险是120min患者的5.955倍;术中失血量≥300ml的患者发生谵妄风险是300ml患者的5.462倍;RD评分≥5分的患者发生谵妄的风险是5分患者的12.777倍。手术方式为全髋关节置换者相较于人工股骨头置换、空心螺钉内固定及股骨近端防旋转螺钉内固定更容易发生谵妄,OR分别为0.385、0.000及0.086。非条件Logistic回归分析结果提示年龄≥75岁、手术方式为全髋关节置换、受伤至手术间隔时间3天、夜间平均睡眠时间≤5h、全麻、麻醉时间≥120min、失血量≥300ml、RD≥5分为影响术后谵妄发生的独立危险因素。结论:1.老年髋部骨折术后谵妄的发生是多因素综合作用的结果;2.术前肝肾功能指标(ALT、AST、Cr、Cyc、GFR)异常不影响术后谵妄的发生;3.年龄、手术方式、受伤至手术的间隔时间、夜间平均睡眠时间、射血分数、麻醉方式、麻醉时间、术中失血量及RD评分为老年患者髋部骨折术后谵妄的影响因素;4.年龄≥75岁、手术方式为全髋关节置换、受伤至手术间隔时间3天、夜间平均睡眠时间≤5h、全麻、麻醉时间≥120min、失血量≥300ml、RD≥5分为影响术后谵妄发生的独立危险因素;5.年龄越大、夜间平均睡眠时间越少、受伤至手术间隔时间越长、麻醉时间越长、术中失血量越大,谵妄的发生风险越大。6.RD谵妄风险评分表能有效用于国人老年髋部骨折谵妄风险的评估;7.夜间平均睡眠时间作为一简易指标能有效评估夜间睡眠状态用于谵妄风险评估。
[Abstract]:Objective: delirium, also known as acute brain syndrome, is mainly manifested in disturbance of consciousness, lack of behavior, concentration of attention, decline of cognitive function, change of awakening, abnormal perception and reversal of day and night, usually in the elderly. Before 2000, F Pokela Di's delirium is described as an acute mental disorder before 2000. But today, the risk factors of delirium are not completely clear, the pathogenesis is not clear, the prevention and treatment measures are not widely used because of many side effects, and the incidence of delirium in the elderly hip fracture is high and the harm is great. Therefore, this experiment is designed to explore the elderly hip. The risk factors for postoperative delirium in patients with fracture, and evaluate the effectiveness of the RD delirium risk rating scale for the assessment of the risk of delirium in Chinese hip fractures, provide theoretical guidance for the occurrence of clinical delirium prevention. Methods: 239 cases of hip fractures in the Southwest Medical University Affiliated Hospital from September 2014 to December 2016 and the patients received surgical treatment were collected. The age was 60-100 years old, with an average of 74 years of age, including 105 males and 134 females, 129 femoral neck fractures, 110 intertrochanteric fractures, 82 Total Hip Arthroplasty, THA, 41 artificial femoral head replacement, 6 hollow screw internal fixation, and proximal femoral screw fixation (Proximal Femoral Nail Antirotation, PFNA) 110 The Confusion Assessment Method (CAM) was used to assess and exclude patients in delirium; a simple mental assessment scale (The Minimum Mental State Examination, MMSE) was used to evaluate the patient's basic cognitive function. The size of the risk of delirium in the patient; to evaluate the patient's delirium by CAM every morning and afternoon except for the operation day, and to exclude patients with delirium in time, and to collect the fracture sites, surgical methods, age, sex, and the mean night sleep time during the admission to the end of the observation period (night). Mean sleep time), interval time of injury to operation (interval time), cardiac ejection fraction, liver and kidney function results of Alanine Aminotransferase, ALT, Aspartate Transaminase, AST, creatinine (Cr), Cystatin C (Cystatin C, CYC), glomerular filtration rate. Omerular Filtration Rate, GFR), history of hypertension and diabetes, anesthesia, anesthesia time, intraoperative blood loss and RD scores and other data and chi square test, the factors of P < 0.1 in the result of chi square test were analyzed by non conditional Logistic regression analysis. Results: 1. of the above data were analyzed by chi square test, and the results prompted age, operation. Methods, the interval of the injury to the operation, the average night time, the ejection fraction, the way of anaesthesia, the time of anesthesia, the amount of blood loss and the RD score were the factors affecting the delirium after the operation of the hip fracture in the elderly; the 2. unconditional Logistic regression analysis showed that the risk of delirium in the patients aged over 75 years was 7.672 times as much as 75 years old. The risk of delirium in patients with 3 days of surgery was 7.820 times more than those in 3 days; the risk of delirium in patients with average sleep time less than 5h at night was 4.132 times as high as that of 5h patients; the risk of delirium in general anesthesia patients was 4.804 times as high as those in subarachnoid anesthesia; patients with anesthesia time more than 120min The risk of delirium was 5.955 times as high as that of 120min patients; the risk of delirium in patients with intraoperative blood loss more than 300ml was 5.462 times as high as that of 300ml patients; the risk of delirium in patients with RD score more than 5 was 12.777 times more than that of 5 patients. OR 0.385,0.000 and 0.086. non conditional Logistic regression analysis showed that age was more than 75 years old, total hip replacement, injury to operation interval 3 days, night average sleep time less than 5h, general anesthesia, anesthesia time more than 120min, blood loss more than 300ml, RD more than 5 to affect postoperative delirium. Conclusion: 1. the occurrence of postoperative delirium in 1. elderly hip fractures is the result of multiple factors; 2. abnormal liver and kidney function indexes (ALT, AST, Cr, Cyc, GFR) have no effect on postoperative delirium; 3. age, operation mode, interval time of injury to operation, night mean sleep time, ejection fraction, anaesthesia Anesthesia time, intraoperative blood loss and RD score were the influencing factors of postoperative delirium in the elderly patients with hip fracture; 4. age or more than 75 years old, total hip replacement, 3 days of operation interval, average sleep time less than 5h at night, general anesthesia, anesthesia time more than 120min, blood loss of more than 300ml, RD more than 5 to affect postoperative delirium only only The higher the 5. age, the less the night average sleep time, the longer the injury to the operation interval, the longer the anesthesia time, the greater the amount of blood loss in the operation, the greater the risk of delirium, the.6.RD delirium risk score table can be effectively used to assess the risk of delirium in the elderly hip fracture, and 7. night average sleep time as a simple indicator. It can effectively assess nocturnal sleep state and assess delirium risk.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
[Abstract]:Objective: delirium, also known as acute brain syndrome, is mainly manifested in disturbance of consciousness, lack of behavior, concentration of attention, decline of cognitive function, change of awakening, abnormal perception and reversal of day and night, usually in the elderly. Before 2000, F Pokela Di's delirium is described as an acute mental disorder before 2000. But today, the risk factors of delirium are not completely clear, the pathogenesis is not clear, the prevention and treatment measures are not widely used because of many side effects, and the incidence of delirium in the elderly hip fracture is high and the harm is great. Therefore, this experiment is designed to explore the elderly hip. The risk factors for postoperative delirium in patients with fracture, and evaluate the effectiveness of the RD delirium risk rating scale for the assessment of the risk of delirium in Chinese hip fractures, provide theoretical guidance for the occurrence of clinical delirium prevention. Methods: 239 cases of hip fractures in the Southwest Medical University Affiliated Hospital from September 2014 to December 2016 and the patients received surgical treatment were collected. The age was 60-100 years old, with an average of 74 years of age, including 105 males and 134 females, 129 femoral neck fractures, 110 intertrochanteric fractures, 82 Total Hip Arthroplasty, THA, 41 artificial femoral head replacement, 6 hollow screw internal fixation, and proximal femoral screw fixation (Proximal Femoral Nail Antirotation, PFNA) 110 The Confusion Assessment Method (CAM) was used to assess and exclude patients in delirium; a simple mental assessment scale (The Minimum Mental State Examination, MMSE) was used to evaluate the patient's basic cognitive function. The size of the risk of delirium in the patient; to evaluate the patient's delirium by CAM every morning and afternoon except for the operation day, and to exclude patients with delirium in time, and to collect the fracture sites, surgical methods, age, sex, and the mean night sleep time during the admission to the end of the observation period (night). Mean sleep time), interval time of injury to operation (interval time), cardiac ejection fraction, liver and kidney function results of Alanine Aminotransferase, ALT, Aspartate Transaminase, AST, creatinine (Cr), Cystatin C (Cystatin C, CYC), glomerular filtration rate. Omerular Filtration Rate, GFR), history of hypertension and diabetes, anesthesia, anesthesia time, intraoperative blood loss and RD scores and other data and chi square test, the factors of P < 0.1 in the result of chi square test were analyzed by non conditional Logistic regression analysis. Results: 1. of the above data were analyzed by chi square test, and the results prompted age, operation. Methods, the interval of the injury to the operation, the average night time, the ejection fraction, the way of anaesthesia, the time of anesthesia, the amount of blood loss and the RD score were the factors affecting the delirium after the operation of the hip fracture in the elderly; the 2. unconditional Logistic regression analysis showed that the risk of delirium in the patients aged over 75 years was 7.672 times as much as 75 years old. The risk of delirium in patients with 3 days of surgery was 7.820 times more than those in 3 days; the risk of delirium in patients with average sleep time less than 5h at night was 4.132 times as high as that of 5h patients; the risk of delirium in general anesthesia patients was 4.804 times as high as those in subarachnoid anesthesia; patients with anesthesia time more than 120min The risk of delirium was 5.955 times as high as that of 120min patients; the risk of delirium in patients with intraoperative blood loss more than 300ml was 5.462 times as high as that of 300ml patients; the risk of delirium in patients with RD score more than 5 was 12.777 times more than that of 5 patients. OR 0.385,0.000 and 0.086. non conditional Logistic regression analysis showed that age was more than 75 years old, total hip replacement, injury to operation interval 3 days, night average sleep time less than 5h, general anesthesia, anesthesia time more than 120min, blood loss more than 300ml, RD more than 5 to affect postoperative delirium. Conclusion: 1. the occurrence of postoperative delirium in 1. elderly hip fractures is the result of multiple factors; 2. abnormal liver and kidney function indexes (ALT, AST, Cr, Cyc, GFR) have no effect on postoperative delirium; 3. age, operation mode, interval time of injury to operation, night mean sleep time, ejection fraction, anaesthesia Anesthesia time, intraoperative blood loss and RD score were the influencing factors of postoperative delirium in the elderly patients with hip fracture; 4. age or more than 75 years old, total hip replacement, 3 days of operation interval, average sleep time less than 5h at night, general anesthesia, anesthesia time more than 120min, blood loss of more than 300ml, RD more than 5 to affect postoperative delirium only only The higher the 5. age, the less the night average sleep time, the longer the injury to the operation interval, the longer the anesthesia time, the greater the amount of blood loss in the operation, the greater the risk of delirium, the.6.RD delirium risk score table can be effectively used to assess the risk of delirium in the elderly hip fracture, and 7. night average sleep time as a simple indicator. It can effectively assess nocturnal sleep state and assess delirium risk.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
【参考文献】
相关期刊论文 前7条
1 郑文迪;赵亮;王玉强;马克;马俊豪;王利民;;骨科手术时间与术后谵妄的相关性的Meta分析[J];河南医学研究;2016年10期
2 喻任;陆纯德;程艳;王U喨，
本文编号：2140527
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2140527.html
最近更新
教材专著
