Objective: To explore postoperative delirium (POD)risk factors for geriatric patients who suffered hip fracture under the care of orthogeriatric unit mode. Methods: Patients aged 65 years or older, who were admitted to the orthogeriatric unit in Beijing Jishuitan Hospital from April to October 2017 for hip fracture surgery, were eligible for this prospective cohort study. After univariable analysis, significant risk factors associated with POD were further evaluated with multivariable analysis, to establish independent risk factors associated with POD. Results: A total of 203 patients with an average age of 80(65-96)years were enrolled in the study. The overall incidence of POD was 9.4%(19/203)in which hyperactive and hypoactive type accounting for 84.2%(16/19)and 15.8%(3/19), respectively. Significant difference was found between POD and non-POD groups in patients' age (P=0.003), albumin(P=0.006), TSH(P=0.018), PaCO(2) level(P=0.003), visual analogue scale (VAS )both at rest (P=0.013)and movement(P=0.010) on post-operative day 1.The further Logistic stepwise regression analysis showed that significant differences existed between groups in age(P=0.027), albumin(P=0.003), PaCO(2)(P=0.014)and VAS at rest(P=0.002). Conclusion: The independent risk factors of POD in geriatric patients undergoing hip fracture under the orthogeriatric unit mode include patients' age, pre-operative albumin as well as PaCO(2) level and post-operative VAS at rest.
目的： 探讨基于老年骨科单元模式下髋部骨折术后谵妄的流行病特征及相关危险因素。 方法： 本研究为前瞻性队列研究，选取2017年4至10月期间北京积水潭医院急诊收治的年龄>65岁、麻醉评估后收入老年骨科单元接受手术治疗的髋部骨折患者。经单因素分析及二元Logistic回归分析筛选出谵妄独立危险因素。 结果： 共203例患者纳入本项研究，平均年龄80(65～96)岁，谵妄发生率为9.4%(19/203)，其中躁动型与淡漠型分别占84.2%与15.8%。单因素方差分析显示两组间年龄(P＝0.003)、白蛋白(P＝0.006)、促甲状腺激素(P＝0.018)、二氧化碳分压(PaCO(2))(P＝0.003)、术后第1天静息视觉模拟评分(VAS)(P＝0.013)及运动VAS(P＝0.010)差异均有统计学意义。二元Logistic回归分析示年龄(P＝0.027)、白蛋白(P＝0.003)、PaCO(2)(P＝0.014)、术后第1天静息VAS(P＝0.018)为术后谵妄的独立危险因素。 结论： 高龄、术前低白蛋白血症及过度通气、术后第1天静息VAS为老年骨科单元模式下髋部骨折术后谵妄的独立危险因素。.
Keywords: Delirium; Hip fracture; Orthogeriatric unit; Risk factors.