摘要
目的分析老年股骨粗隆间骨折患者防旋股骨近端髓内钉(PFNA)术后谵妄的发生情况及影响因素。方法收集2019年12月至2021年9月在空军军医大学第二附属医院接受PFNA术治疗的217例老年股骨粗隆间骨折患者的临床资料进行回顾性分析。统计术后7 d内老年股骨粗隆间骨折患者术后谵妄发生情况,根据是否发生谵妄分为谵妄组和非谵妄组,采用单因素和多因素Logistic回归分析影响老年股骨粗隆间骨折患者PFNA术后谵妄发生的危险因素。结果PFNA术后7 d内,217例老年股骨粗隆间骨折患者中共31例发生谵妄,发生率约为14.29%(31/217)。单因素分析结果显示,谵妄组年龄≥75岁、全身麻醉患者比例及电解质紊乱发生率高于非谵妄组[77.42%(24/31)比46.77%(87/186)、48.39%(15/31)比27.96%(52/186)](P<0.05或P<0.01),隐性失血量大于非谵妄组[(615±31)ml比(526±26)ml](P<0.01),C反应蛋白(CRP)和D-二聚体水平高于非谵妄组[(75±6)mg/L比(62±5)mg/L、(2.18±0.37)μg/L比(1.24±0.28)μg/L](P<0.01)。Logistic回归分析结果显示,年龄≥75岁、全身麻醉、电解质紊乱、隐性失血量大,CRP、D-二聚体水平高是影响老年股骨粗隆间骨折患者PFNA术后谵妄发生的危险因素(P<0.05或P<0.01)。结论影响老年股骨粗隆间骨折患者PFNA术后谵妄发生的因素复杂,临床需根据患者整体情况制订科学有效的治疗方案。
Objective To analyze the incidence and influencing factors of delirium after proximal femoral nail antirotation(PFNA)in elderly patients with intertrochanteric fractures.Methods The clinical data of 217 elderly patients with femoral intertrochanteric fractures who received PFNA treatment in the Second Affiliated Hospital of Air Force Military Medical University from Dec.2019 to Sep.2021 were collected for retrospective analysis.The incidence of postoperative delirium in the elderly patients with femoral intertrochanteric fracture within 7 days after surgery was counted,and they were divided into a delirium group and a non-delirium group according to whether delirium occurred or not.Univariate and multivariate Logistic regression was used to analyze the risk factors of delirium after PFNA in the elderly patients with intertrochanteric fractures.Results Within 7 days after PFNA,delirium occurred in 31 of the 217 patients,with an incidence of 14.29%(31/217).Univariate analysis showed that the age≥75 years old,the proportion of general anesthesia patients and the incidence of electrolyte disorder of the delirium group were higher than that of the non-delirium group[77.42%(24/31)vs 46.77%(87/186),48.39%(15/31)vs 27.96%(52/186)](P<0.05 or P<0.01),the occult blood loss was greater than that of the non-delirium group[(615±31)ml vs(526±26)ml](P<0.01),and the C-reactive protein(CRP)and D-dimer levels were higher than that of the non-delirium group[(75±6)mg/L vs(62±5)mg/L,(2.18±0.37)μg/L vs(1.24±0.28)μg/L](P<0.01).Logistic regression analysis showed that age≥75 years,general anesthesia,electrolyte imbalance,large hidden blood loss,high CRP and D-dimer levels were the risk factors for delirium after PFNA in the elderly patients with femoral intertrochanteric fractures(P<0.05 or P<0.01).Conclusion The factors affecting the occurrence of delirium after PFNA in elderly patients with intertrochanteric fractures are complex,and a scientific and effective clinical treatment plan must be formulated according to the over
作者
郑莎
孙嗣国
冯倩
徐飞
尹丹娜
白洁
ZHENG Sha;SUN Siguo;FENG Qian;XU Fei;YIN Danna;BAI Jie(Department of Orthopedics,the Second Affiliated Hospital of Air Force Medical University,Xi′an 710038,China;Department of Orthopedics,Air Force Special Medical Center,Beijing 100142,China)
出处
《医学综述》
CAS
2022年第22期4543-4547,共5页
Medical Recapitulate
基金
陕西省社会发展科技攻关项目(2016SF-140)。
关键词
股骨粗隆间骨折
老年
防旋股骨近端髓内钉术
谵妄
危险因素
Intertrochanteric fractures
Elderly
Proximal femoral nail antirotation
Delirium
Risk factors
