CAJ | 학술논문

目的探讨谵妄与老年髋部骨折患者术后血容量改变的相关性,为治疗和预防提供参考.方法连续性观察150例接受手术治疗的老年髋部骨折患者.谵妄的评估采用CAM(confusion assessment method)量表.收集其术前、术中及术后的数据,用Logistic回归分析血容量改变与谵妄的相关性.结果 59例患者(男28例,女31例)术后出现了谵妄,发生率为39.3％(59/150).谵妄组平均年龄(77.71 ±6.63)岁,高于无谵妄组患者(73.79±5.42)岁,两组比较差异有统计学意义(t=-3.958,P＜0.001).谵妄组患者术前及术后第7天平均血红蛋白浓度、红细胞比容均低于未出现谵妄组[术前分别为(117.80±16.59)、(123.92±14.61)g/L,t =2.378,P=0.019;0.355±0.154、0.372±0.210,t =2.291,P=0.023;术后第7天(98.15±11.51)、(102.33±9.88) g/L,t=2.369,P=0.019;0.296±0.040、0.306±0.030,t=-3.958,P＜0.001].两组间在性别、骨折类型、手术方式、手术时间、失血量及术后1、3d血红蛋白浓度间差异无统计学意义(P均＞0.05).经Logistic回归分析,患者的年龄、教育程度及术后第7天血红蛋白含量在是否出现谵妄两组间差异有统计学意义(OR分别为3.28、1.097、0.389,P均＜0.05).结论高龄髋部骨折患者发生谵妄是一个多因素结果,高龄、术后持续低血红蛋白浓度、受教育程度低患者的谵妄发生概率高.
목적 탐토섬망여노년관부골절환자술후혈용량개변적상관성,위치료화예방제공삼고.방법 련속성관찰150례접수수술치료적노년관부골절환자.섬망적평고채용CAM(confusion assessment method)량표.수집기술전、술중급술후적수거,용Logistic회귀분석혈용량개변여섬망적상관성.결과 59례환자(남28례,녀31례)술후출현료섬망,발생솔위39.3％(59/150).섬망조평균년령(77.71 ±6.63)세,고우무섬망조환자(73.79±5.42)세,량조비교차이유통계학의의(t=-3.958,P＜0.001).섬망조환자술전급술후제7천평균혈홍단백농도、홍세포비용균저우미출현섬망조[술전분별위(117.80±16.59)、(123.92±14.61)g/L,t =2.378,P=0.019;0.355±0.154、0.372±0.210,t =2.291,P=0.023;술후제7천(98.15±11.51)、(102.33±9.88) g/L,t=2.369,P=0.019;0.296±0.040、0.306±0.030,t=-3.958,P＜0.001].량조간재성별、골절류형、수술방식、수술시간、실혈량급술후1、3d혈홍단백농도간차이무통계학의의(P균＞0.05).경Logistic회귀분석,환자적년령、교육정도급술후제7천혈홍단백함량재시부출현섬망량조간차이유통계학의의(OR분별위3.28、1.097、0.389,P균＜0.05).결론 고령관부골절환자발생섬망시일개다인소결과,고령、술후지속저혈홍단백농도、수교육정도저환자적섬망발생개솔고.
Objective To explore the relationship of blood volume changes and postoperative delirium in elderly patients undergoing surgery for hip fracture.Methods One hundred and fifty elderly patients who underwent surgery for hip fracture were enrolled in the study.Delirium was diagnosed by Confusion Assessment Method(CAM).Preoperative,intraoperative and postoperative data were collected,and the correlation of postoperative delirium and blood volume changes were analyzed by logistic regression analysis.Results A total of 59 patients(28 males and 31 females)had delirium after surgery and the occurrence rate of postoperative delirium was 39.3％ (59/150).The average age in delirium group was significantly older than that in the control group[ (77.71 ±6.63)years old vs(73.79 ±5.42) years old,t =-3.958,P ＜0.001 ].The average hemoglobin concentration and hematocrit in delirium group were both less than that in control group whether before surgery or at 7 days after surgery( before surgery:average hemoglobin concentration:[ ( 117.80 ± 16.59)g/L vs( 123.92 ±14.61 ) g/L,t =2.378,P =0.019; hematocrit:(0.355 ± 0.154) vs(0.372 ± 0.210),t =2.291,P =0.023 ;7days after surgery:average hemoglobin concentration:(98.15 ± 11.51 ) g/L vs ( 102.33 ± 9.88 ) g/L,t =2.369,P =0.019; hematocrit:(0.296 ± 0.040 ) vs (0.306 ± 0.030),t =-3.958,P ＜ 0.001 ].There was no significant difference on gender,fracture type,surgical approach,operative time,blood loss and hemoglobin concentration at 1,3 days after surgery between the two groups( P ＞0.05 ).Logistic regression analysis showed that age ( OR 3.280 ),education ( OR 0.389 ),and hemoglobin concentration at 7 days after operration ( OR 1.097) were significantly related to the occurrence of postoperative delirium ( P ＜ 0.05 ).Conclusion Our findings suggest that the risk for postoperative delirium is the result of more than one factor.Older age,continued postoperative low hemoglobin concentration and low degree of education present high risk of delirium in patients underwent surgery for hip fractures.