老年患者髋部骨折术后谵妄危险因素分析贾佩玉郭勇王学敏江伟作者.doc

老年患者髋部骨折术后谵妄危险因素分析 贾佩玉 郭勇 王学敏 江伟 作者单位：上海交通大学附属第六人民医院麻醉科，上海，200233 第一作者：贾佩玉，男，硕士研究生。 通信作者：王学敏，主任医师，教授。 E-mail：wangxm@sjtu, 摘要 目的：探究老年患者髋部骨折术后谵妄发生危险因素，减少术后谵妄发生提供依据。 方法：选取286例髋部骨折后行单侧全髋关节置换老年患者，术后发生谵妄60例，发生率为21%，未发生谵妄患者226例作为非谵妄组。收集患者病史资料，实验室检查，手术及麻醉相关资料等，将可能的危险因素进行组间分析，随后将具有统计学差异的指标进行logistic回归分析。 结果：两组患者平均年龄，脑梗史，房颤史，白细胞计数，红细胞计数，血小板计数，血红蛋白，红细胞压积，中性粒细胞百分比，白蛋白，总蛋白，总胆红素，直接胆红素，凝血酶原时间，活化部分凝血活酶时间，血糖，C反应蛋白，术中出血量，输红细胞具有统计学差异。logistic回归分析显示: 平均年龄，总胆红素，血糖，C反应蛋白，输红细胞成为此次研究的独立危险因素。 结论：老年患者髋部骨折单侧全髋关节置换术后危险因素主要为平均年龄，总胆红素，血糖，C反应蛋白，输红细胞。 关键词 术后谵妄 危险因素 老年患者 髋部骨折 Abstract Objective To explore the risk factors of postoperative delirium in elderly patients with hip fracture, in order to reduce the incidence of delirium. Methods We select 286 cases undergoing hip fracture surgery, divided two groups--226 cases of non-delirium and 60 cases of delirium group. The incidence of delirium is 21%. We take blood routine, liver and kidney function, inflammatory markers, glucose, preoperative underlying diseases, duration of hospitalization, anesthesia and surgery into risk factors. Statistical analysis is performed using SPSS19.0 software. Results Average age, cerebral infarction history, atrial fibrillation history, white blood cells, red blood cells, platelet, hemoglobin, hematocrit, the percentage of neutrophils, albumin, total protein, total bilirubin, direct bilirubin, prothrombin time, activated partial thromboplastin time, blood glucose, C-reactive protein, hemorrhage of during surgery, red blood cells transfusion have significant difference in the univariate analysis. Logistic regression analysis showed that average age, total bilirubin , blood glucose, C-reactive protein, red blood cells transfusion are significantly different. Conclusion The risk factors of postoperative delirium in elderly patients with hip fracture are average age, total bilirubin , blood glucose, C-reactive protein, red blood cells transfusion. Key words postoperative delirium; risk factors; elderly pat