老年骨折患者谵妄的发生率及危险因素分析

摘要

目的 研究老年骨折患者保守治疗期间谵妄的发生情况,分析其危险因素.方法 选择2012年1月～2016年12月住我院南楼的老年骨折保守治疗患者152例,记录基本资料和相关检查指标.采用意识模糊评估法评估患者是否发生谵妄,于骨折后30 d内每2d评估1次,分析患者发生谵妄的危险因素.结果 152例患者中62例(40.8％)发生谵妄,58.1％在骨折后10 d内发生谵妄,以混合型谵妄为主(46.8％),随时间延长,活动过少型谵妄逐渐增多.谵妄多发于多发肋骨骨折和髋部骨折,多因素回归分析提示,腔隙性脑梗死(OR=0.122,95％CI:0.017～0.887,P=0.038)、美国麻醉医师协会(ASA)分级≥3级(OR=9.061,95％CI:1.484～55.340,P=0.017)、疼痛评分(OR=5.554,95％CI:1.630～18.922,P=0.006)、全身性炎症反应综合征(SIRS,OR=10.640,95％CI:1.401～80.822,P=0.022)、C反应蛋白(OR=1.221,95％CI:1.047～1.425,P=0.011)是老年骨折患者发生谵妄的独立危险因素.结论 谵妄是老年多发肋骨骨折或髋部骨折后常见的并发症,骨折后谵妄初发窗口期长,大部分在骨折后10 d内,后期以活动过少型谵妄为主.多发腔隙性脑梗死、ASA分级≥3级、剧烈疼痛、SIRS状态、C反应蛋白升高是老年非颅骨骨折患者发生谵妄的独立危险因素.%Objective To study the risk factors for delirium by investigating its incidence in elderly fracture patients undergoing conservative treatment.Methods One hundred and fifty-two elderly fracture patients admitted to our hospital for conservative treatment from January 2012 to November 2016 were included in this study.Their baseline data and relevant examination data were recorded.Their delirium was assessed every 2 days after 30 days of fracture.The risk factors for delirium were analyzed.Results Delirium occurred in 62 (40.8％) and 88 (58.1％) out of the 152 patients within 10 days after fracture.Mixed delirium accounted for 46.8％.The occurrence of hypoactive delirium increased with the increasing time.Delirium usually occurred in rib and femur neck fracture patients.Multivariate logistic regression analysis showed that history of preoperative cerebral accidents,high ASA score,severe pain,SIRS status,high CRP level were the risk factors for delirium (OR=0.122,95％CI:0.017-0.887,P=0.038;OR=9.061,95％CI:1.484-55.340,P=0.017;OR=5.554,95％CI:1.630-18.922,P=0.006;OR=10.640,95％CI:1.401-80.822,P=0.022;OR=1.221,95％CI:1.047-1.425,P=0.011).Conclusion Delirium is a common complication of rib or femur neck fractures.Delirium usually occurs within 10 days after fracture.History of preoperative cerebral accidents,high ASA score,severe pain,SIRS status and high CRP level are the risk factors for delirium in elderly fracture patients.