CAJ | 학술논문

目的分析骨科常见手术术后发生谵妄的相关危险因素.方法回顾性分析2011年1月至2013年12月行股骨转子间骨折内固定术(155例)、人工股骨头置换术(64例)、全髋关节置换术(169例)、膝关节置换术(65例)和肩关节周围手术(72例)患者525例,根据是否发生术后谵妄分为谵妄组(56例)和非谵妄组(469例).记录谵妄组和非谵妄组患者年龄、性别、血型以及住院天数、手术方式、麻醉方式、术前准备时间、术前基础疾病状况、术前及术后白蛋白、术前及术后血红蛋白水平、术后电解质是否紊乱、术中出血量、手术持续时间、术后是否ICU监护和输血量等围手术期因素共17项.采用单因素和多因素Logistic回归分析术后发生谵妄的相关危险因素.结果单因素Logistic回归分析结果显示,可能与术后谵妄相关的因素有年龄、手术方式、术前准备时间、术前白蛋白水平、术前血红蛋白水平、术后电解质是否紊乱、手术持续时间、是否术后ICU监护和输血量等9项.多因素Logistic回归分析显示:年龄70～80岁和＞80岁组术后谵妄发生率高于年龄＜70岁组,OR值分别为12.998(95％CI:2.829,59.713)和36.210(95％CI:8.222,159.476);术前准备时间4～6 d组术后谵妄发生率高于术前准备时间≥7 d组,OR值为3.903(95％CI:1.658,9.188);术后电解质紊乱组术后谵妄的发生率高于电解质正常组,OR值为2.160(95％CI:1.065,4.382).结论高龄、术前准备时间不充分和术后电解质紊乱是骨科术后发生谵妄的高危因素.
목적 분석골과상견수술술후발생섬망적상관위험인소.방법 회고성분석2011년1월지2013년12월행고골전자간골절내고정술(155례)、인공고골두치환술(64례)、전관관절치환술(169례)、슬관절치환술(65례)화견관절주위수술(72례)환자525례,근거시부발생술후섬망분위섬망조(56례)화비섬망조(469례).기록섬망조화비섬망조환자년령、성별、혈형이급주원천수、수술방식、마취방식、술전준비시간、술전기출질병상황、술전급술후백단백、술전급술후혈홍단백수평、술후전해질시부문란、술중출혈량、수술지속시간、술후시부ICU감호화수혈량등위수술기인소공17항.채용단인소화다인소Logistic회귀분석술후발생섬망적상관위험인소.결과 단인소Logistic회귀분석결과현시,가능여술후섬망상관적인소유년령、수술방식、술전준비시간、술전백단백수평、술전혈홍단백수평、술후전해질시부문란、수술지속시간、시부술후ICU감호화수혈량등9항.다인소Logistic회귀분석현시:년령70～80세화＞80세조술후섬망발생솔고우년령＜70세조,OR치분별위12.998(95％CI:2.829,59.713)화36.210(95％CI:8.222,159.476);술전준비시간4～6 d조술후섬망발생솔고우술전준비시간≥7 d조,OR치위3.903(95％CI:1.658,9.188);술후전해질문란조술후섬망적발생솔고우전해질정상조,OR치위2.160(95％CI:1.065,4.382).결론 고령、술전준비시간불충분화술후전해질문란시골과술후발생섬망적고위인소.
Objective To explore the risk factors for delirium after orthopedic surgery.Methods Retrospective analysis of 525 patients who underwent orthopedic surgery from January 2011 to December 2013 was carried out.Among 525 patients,155 patients experienced internal fixation for intertrochanteric fracture;64 patients experienced femoral head prosthetic replacement;169 patients experienced total hip replacement;65 patients experienced total knee arthroplasty and 72 patients experienced shoulder joint surgery.All the 525 patients were divided into delirium group (56 cases) and non-delirium group (469 cases).17 perioperative factors were recorded,including age,gender,blood type,operation methods,anesthesia mode,preoperative preparation time,basic disease,preoperative and postoperative albumin levels,preoperative and postoperative hemoglobin levels,postoperative electrolyte disturbance,bleeding volume,operation duration,ICU monitoring and blood transfusion volume.Single factor Logistic regression and multi-factor Logistic regression analysis were applied to discuss related risk factors of postoperative delirium.Results Results of single Logistic regression analysis indicate that 9 factors including age,operation methods,preoperative preparation time,preoperative albumin and hemoglobin level,postoperative electrolyte disturbance,operation duration,ICU monitoring and blood transfusion volume might be related to postoperative delirium.Multi-factor Logistic regression analysis show that postoperative delirium occurrence rate of the group with the age 70-80 and the group with the age ＞80 is higher than that of the group with the age ＜70.OR values are 12.998 and 36.210.In terms of preoperative preparation time,postoperative delirium occurrence rate of the group with preoperative preparation time of 4-6 d is higher than that the group with preoperative preparation time more than or equal to 7 d.OR value is 3.903.Postoperative delirium occurrence rate of electrolyte disturbance group is higher than that of normal electrolyte group.OR value is 2.160.Conclusion The old age,insufficient preoperative preparation and postoperative electrolyte disturbance are high risk factors for postoperative delirium.