CAJ | 학술논문

目的：分析不同手术方式对高龄髋部骨折患者术后谵妄的影响，总结相关影响因素。方法：2007年8月-2010年8月收治高龄髋部骨折患者130例，根据手术方式的不同，分为两组。结果：B组术后的谵妄发生率显著低于A组，差异有统计学意义(P＜0.05)；A组首次及末次的DRS评分均显著高于B组，差异均有统计学意义(P＜0.05)；B组的谵妄持续时间明显比A组更短，差异有统计学意义(P＜0.05)；A组的低氧血症发生例数明显比B组更多，差异有统计学意义(P＜0.05)；B组在睡眠时间减少及疼痛评分方面，均显著优于A组，差异有统计学意义(P＜0.05)；B组术前血压异常、电解质紊乱改善情况明显优于A组，差异有统计学意义(P＜0.05)；另A1组和A2组、B1组和B2组之间谵妄发生情况对比差异无统计学意义(P＞0.05)。结论：高龄髋部骨折患者受心理因素、手术打击、睡眠紊乱、药物、年龄、血压、电解质紊乱等因素影响，但不受术前麻醉方式影响，对于高龄髋部骨折患者行髋关节置换术治疗，其发生谵妄的概率比行内固定术者更高，临床上应当对髋关节置换术后谵妄的发生引起充分的重视。
목적：분석불동수술방식대고령관부골절환자술후섬망적영향，총결상관영향인소。방법：2007년8월-2010년8월수치고령관부골절환자130례，근거수술방식적불동，분위량조。결과：B조술후적섬망발생솔현저저우A조，차이유통계학의의(P＜0.05)；A조수차급말차적DRS평분균현저고우B조，차이균유통계학의의(P＜0.05)；B조적섬망지속시간명현비A조경단，차이유통계학의의(P＜0.05)；A조적저양혈증발생례수명현비B조경다，차이유통계학의의(P＜0.05)；B조재수면시간감소급동통평분방면，균현저우우A조，차이유통계학의의(P＜0.05)；B조술전혈압이상、전해질문란개선정황명현우우A조，차이유통계학의의(P＜0.05)；령A1조화A2조、B1조화B2조지간섬망발생정황대비차이무통계학의의(P＞0.05)。결론：고령관부골절환자수심리인소、수술타격、수면문란、약물、년령、혈압、전해질문란등인소영향，단불수술전마취방식영향，대우고령관부골절환자행관관절치환술치료，기발생섬망적개솔비행내고정술자경고，림상상응당대관관절치환술후섬망적발생인기충분적중시。
Objective:To analyze the influence of different operation ways on the postoperative delirium of elderly patients with hip fracture.Methods:130 elderly patients with hip fracture were selected from August 2007 to August 2010.They were divided into two groups according to the different operation ways.Results:The postoperative delirium incidence rate of patients in B groups was significantly lower than that of A group;the difference was statistically significant(P<0.05).The first and the last DRS scores of patients in A group were significantly higher than these of B group;the differences were statistically significant(P<0.05).The delirium duration of B group was shorter than that of A group;the difference was statistically significant(P<0.05).The hypoxemia happened cases of A group was more than that of B group;the difference was statistically significant(P<0.05).The sleep time reduced and pain score of B group were significantly better than these of A group;the difference was statistically significant(P<0.05).The mend matters of abnormal preoperative blood pressure and electrolyte disturbance in B group were significantly higher than those of A group;the difference was statistically significant(P<0.05).The differences of delirium occurred between A1 and A2 group,B1 and B2 group were not obvious;the diffenence was not statistical significance(P>0.05).Conclusion:The elderly patients with hip fracture are influenced by some factors,such as psychological factors,surgical strike,sleep disorders,drug,age, blood pressure,electrolyte disorder and so on,but it is not influenced by anesthesia method.The probability of occurrence delirium in hip replacement therapy is higher than the internal fixation for the elderly patients with hip fracture.We should pay full attention on the incidence of delirium after hip replacement in clinical.