老年髋部骨折患者术后谵妄发生现况及危险因素分析

摘要

目的:了解老年髋部骨折患者术后谵妄(Postoperative Delirium,POD)发生现状,分析其危险因素并评价危险因素的预测效能.方法 :术前采用谵妄影响因素调查表及衰弱量表评估患者,术后以意识模糊评估法评估 POD 发生情况,并记录患者的症状.经多因素 Logistic 回归分析明确 POD 的危险因素,采用受试者工作特征曲线分析模型中各因素的预测效能及确定连续性变量的危险分界点.结果 :217 例患者中有 63 例发生 POD,发生率为 29％ ;多因素分析显示年龄、术前衰弱、脑卒中史、术中低氧及 ICU 住院时长是老年髋部骨折患者发生 POD 的危险因素 ;ROC 曲线分析显示,年龄、术前衰弱和 ICU 住院时长对 POD 的预测效能中等,脑卒中史和术中低氧的预测效能较低,年龄、ICU 住院时长、衰弱状态的危险分界点分别为 80 岁、1 天和衰弱前期.结论 :老年髋部骨折患者术后谵妄发生率较高,年龄 >80 岁、术前处于衰弱前期或衰弱状态、有脑卒中史、术中低氧及 ICU住院时长超过 1 天的患者易发生 POD.%Objective: To investigate the incidence and risk factors of postoperative delirium (POD)in elderly hip fracture patients and evaluate the predictive effcacy of these risk factors. Method: The subjects who met the inclusion criteria were evaluated by the self-designed postoperative delirium influencing factors questionnaire and the FRAIL scale before the operation, and the full version of Confusion Assessment Method was used to diagnose POD, and the clinical manifestations were recorded after the operation. The risk factors of POD were determined by multivariate Logistic regression analysis, and the receiver operating characteristic (ROC)curve was used to evaluate the predictive effcacy and determine the cut-off value. Results: POD occurred in 63 of 217 patients (29％). Multivariate analysis showed that age, preoperative frailty, stroke, intraoperative hypoxia, and length of ICU stay were risk factors for POD. ROC curve analysis showed that age, preoperative frailty and length of ICU stay were with moderate predictive efficacy, stroke and intraoperative hypoxia were with low predictive efficacy for POD. The cut-off value of age, ICU stay and frailty status were 80 years old, 1 day and pre-frail respectively. Conclusion: The incidence of POD is high in elderly hip fracture patients. Age over 80, preoperative pre-frail or frailty, a history of stroke, intraoperative hypoxia and ICU stay more than 1 day could predict the occurrence of POD.