【摘要】 目的分析老年患者髋关节置换术后谵妄(POD)和术后认知功能障碍(POCD)的危险因素。方法本院2010年5月至2012年8月择期硬膜外麻醉髋关节置换术老年患者200例。采用意识错乱评估方法(CAM)判定术后2d内患者是否发生POD。采用简易精神状态量表(MMSE)判定术后7d内患者是否发生POCD。采用Logistic回归分析POD和POCD的危险因素。结果术后2d内有31例(15.5%)患者发生POD。术后7d内有56例(28.0%)患者发生POCD。年龄>75岁(OR1.88,95%CI1.48～3.23)、受伤时间>15h(OR1.63,95%CI1.01～3.15)、受教育程度<9年(OR2.73,95%CI1.27～5.78)、术前抑郁(OR1.61,95%CI1.06～2.65)、糖尿病(OR1.43,95%CI1.24～3.19)和术中低血压(OR1.23,95%CI1.05～2.75)是POD的危险因素。年龄>80岁(OR1.77,95%CI1.11～3.54)、受伤时间>15h(OR1.22,95%CI1.14～2.51)、每周饮酒量>5个单位(OR2.14,95%CI1.27～4.65)、受教育程度<12年(OR2.97,95%CI1.81～3.15)、术前抑郁(OR1.14,95%CI1.02～2.90)、糖尿病(OR1.13,95%CI1.04～3.47)、VAS评分>4分(OR1.37,95%CI1.19～3.49)和术中低血压(OR1.14,95%CI1.01～3.15)是POCD的危险因素。结论年龄、受伤时间、受教育程度、术前抑郁、糖尿病和术中低血压是老年患者髋关节置换术后POD和POCD的共同危险因素。更多还原

【Abstract】 Objective To determine the risk factors for post-operative delirium(POD) and post-operative cognitive dysfunction(POCD) in elderly patients undergoing hip joint replacement surgery.Methods We selected 200 elderly patients under epidural anesthesia and scheduled for hip joint replacement surgery from 2010 to 2012 in Qingdao Municipal Hospital. POD was assessed by confusion assessment method(CAM) at 2 days after operation.Cognitive function was assessed by Mini-Mental State Examination(MMSE),at 7 days after operation. The factor was analyzed using multi-factor logistic regression to select risk factor for incidence of POD and POCD.Results Thirty-one patients developed POD(15.5%).Fifty-six patients developed POCD(28.0%).The results of multivariate logistic analysis showed that the risk factors for POD were the age>75 years old (OR 1.88,95%CI 1.48-3.23), injury time>15 h(OR 1.63,95%CI 1.01-3.15), education<9 years (OR 2.73,95%CI 1.27-5.78) preoperative depression(OR 1.61,95%CI 1.06-2.65), diabetes (OR 1.43,95%CI 1.24-3.19), intraoperative hypotension (OR 1.23,95%CI 1.05-2.75);and risk factors for POCD were the age>80 years old(OR 1.77,95%CI 1.11-3.54),injury time>15 h(OR 1.22,95%CI 1.14-2.51), intraoperative hypotension(OR 1.14,95%CI 1.01-3.15), preoperative depression(OR 1.14,95%CI 1.02-2.90),alcohol comsumption per week>5 Units(OR 2.14,95%CI 1.27-4.65),education<12 years(OR 2.97,95%CI 1.81-3.15),diabetes(OR 1.13,95%CI 1.04-3.47),VAS score>4(OR 1.37,95%CI 1.19-3.49).Conclusion Age, injury time, preoperative depression, years of education,diabetes and intraoperative hypotension were the common risk factors for postoperative delirium and postoperative cognitive dysfunction.更多还原