无痛病房对老年髋部骨折术后谵妄影响研究.docVIP

无痛病房对老年髋部骨折术后谵妄影响研究 　　【摘要】 目的：探讨无痛病房对老年髋部骨折手术后出现谵妄情况的影响。方法：回顾性分析2013年5月-2016年5月本院75例行髋部手术的65岁以上老年患者资料，分为无痛病房组47例，普通病房组28例。根据美国精神疾病协会制定的意识错乱评估方法（CAM）对患者精神状况进行评估，采用疼痛视觉模拟评分（VAS）对患者疼痛进行评分，并对最终结果进行统计及分析。结果：两组患者在术前基本情况、手术时间、术中出血量比较差异均无统计学意义（P0.05）；两组患者在术后第1、3天的VAS评分、住院天数及术后谵妄发生情况比较，无痛病房组均优于普通病房组，比较差异均有统计学意义（P0.05）。结论：疼痛是导致老年髋部骨折术后谵妄发生的重要原因，无痛病房的疼痛规范化管理有助于减少老年髋部骨折术后谵妄发生，值得临床推广。 　　【关键词】 无痛病房； 老年髋部骨折； 术后谵妄 　　Study of GPM-Ward on Postoperative Delirium in Elder Patients with Hip Fracture/DONG Yun-peng，ZHENG Xuan，LYU Zhao-hui，et al.//Medical Innovation of China，2017，14（10）：029-032 　　【Abstract】 Objective：To study effects of good pain management ward（GPM-Ward） on postoperative delirium（POD） in elder patients with hip fracture.Method：A total of 75 elder cases with hip fractures were gathered in this retrospective study.47 cases were included in the GPM-Ward group，28 cases were in the conventional ward group.Assessments of delirium were based on confusion assessment method（CAM）.Assessments of pain were based on visual analog score（VAS）.Final result was analysed.Result：There were no statistical significance in preoperative basic situation，operation time and intraoperative bleeding of two groups（P0.05）.After the first and third day treatment，there were statistical significance in VAS postoperative，hospitalization days and the incidence rate of POD in two groups，the GPM-Ward group of those were better than conventional ward group（P0.05）.Conclusion：Pain is an important reason leading to POD occurrence of hip fracture.GPM-Ward may reduce the incidence of POD. 　　【Key words】 Good pain management ward（GPM-Ward）； Elderly hip fracture； Postoperative delirium（POD） 　　First-author’s address：Guangdong Second Traditional Chinese Medicine Hospital，Guangzhou 510095，China 　　doi：10.3969/j.issn.1674-4985.2017.10.008 　　疼痛是每一个创伤骨科医生和患者都要面临的问题，如何解决骨折患者的疼痛问题，可直接影响到患者的治疗及康复。术后谵妄（postoperative delirium，POD）是一种手术后急性意识模糊状态，伴有注意力、感受、思维、记忆、精神运?雍退?眠周期障碍的短暂器质性脑综合征[1]。髋部骨折是老年人常见损伤，主要包括股骨颈骨折、股骨粗隆间骨折和股骨粗隆