首页> 外文期刊>The journals of gerontology.Series A. Biological sciences and medical sciences >Relationship between pain and opioid analgesics on the development of delirium following hip fracture.
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Relationship between pain and opioid analgesics on the development of delirium following hip fracture.

机译:疼痛和阿片类镇痛药对髋部骨折后ir妄发展的关系。

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BACKGROUND: Delirium and pain are common following hip fracture. Untreated pain has been shown to increase the risk of delirium in older adults undergoing elective surgery. This study was performed to examine the relationship among pain, analgesics, and other factors on delirium in hip fracture patients. METHODS: We conducted a prospective cohort study at four New York hospitals that enrolled 541 patients with hip fracture and without delirium. Delirium was identified prospectively by patient interview supplemented by medical record review. Multiple logistic regression was used to identify risk factors. RESULTS: Eighty-seven of 541 patients (16%) became delirious. Among all subjects, risk factors for delirium were cognitive impairment (relative risk, or RR, 3.6; 95% confidence interval, or CI, 1.8-7.2), abnormal blood pressure (RR 2.3, 95% CI 1.2-4.7), and heart failure (RR 2.9, 95% CI 1.6-5.3). Patients who received less than 10 mg of parenteral morphine sulfate equivalents per day were more likely todevelop delirium than patients who received more analgesia (RR 5.4, 95% CI 2.4-12.3). Patients who received meperidine were at increased risk of developing delirium as compared with patients who received other opioid analgesics (RR 2.4, 95% CI 1.3-4.5). In cognitively intact patients, severe pain significantly increased the risk of delirium (RR 9.0, 95% CI 1.8-45.2). CONCLUSIONS: Using admission data, clinicians can identify patients at high risk for delirium following hip fracture. Avoiding opioids or using very low doses of opioids increased the risk of delirium. Cognitively intact patients with undertreated pain were nine times more likely to develop delirium than patients whose pain was adequately treated. Undertreated pain and inadequate analgesia appear to be risk factors for delirium in frail older adults.
机译:背景:髋骨骨折后,Deli妄和疼痛很常见。研究表明,未经治疗的疼痛会增加接受择期手术的老年人发生ir妄的风险。这项研究的目的是检查髋部骨折患者的疼痛,止痛药和其他factors妄因素之间的关系。方法:我们在纽约的四家医院进行了一项前瞻性队列研究,入组541例无hip骨骨折的髋部骨折患者。 r妄是通过患者访谈和病历复查来确定的。采用多元逻辑回归分析确定危险因素。结果:541名患者中有87名(16%)变得神志不清。在所有受试者中,ir妄的危险因素为认知障碍(相对危险或RR,3.6; 95%置信区间或CI,1.8-7.2),血压异常(RR 2.3、95%CI 1.2-4.7)和心脏故障(RR 2.9,95%CI 1.6-5.3)。每天接受少于10毫克肠胃外硫酸吗啡当量的患者比接受更多镇痛的患者更容易出现del妄(RR 5.4,95%CI 2.4-12.3)。与接受其他阿片类镇痛药的患者相比,接受哌替啶的患者发生del妄的风险更高(RR 2.4,95%CI 1.3-4.5)。在认知完好的患者中,剧烈疼痛显着增加了ir妄的风险(RR 9.0,95%CI 1.8-45.2)。结论:使用入院数据,临床医生可以识别出髋部骨折后发生del妄的高风险患者。避免使用阿片类药物或使用非常低剂量的阿片类药物会增加发生ir妄的风险。知觉完好的疼痛不足的患者发生del妄的可能性是疼痛得到适当治疗的患者的九倍。疼痛不足和镇痛不足似乎是脆弱的老年人del妄的危险因素。

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