人工关节置换术后谵妄的风险因子评估及临床分析

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Abstract Objective To evaluate the incidence and risk factors for postoperative delirium in artificial joint arthroplasty.Methods 212 patients who met the criteria for artificial joint replacement from August 2014 to May 2015 were selected.There were 157 females and 55 males，with a mean age of (73.9±5.2)years (range 60~91 years).Delirium was assessed by the delirium scale，the evaluating method of disturbance of consciousness.The patients were divided into delirium group and non-delirium group.General conditions，medical history，surgically related indicators，1~3 d postoperative laboratory examination and other indicators were recorded.Statistical analysis of the differences in clinical indicators between the two groups，multivariate Logistic regression analysis of postoperative delirium independent risk factors.Results A total of 35 cases (16.5%)were found to have delirium.There were 25 females and 10 males，with a mean age of (81.8±4.9)years (range 68~91 years).The majority of postoperative delirium (85.7%)occurred at 72hafter operation.The incidence of delirium after hip replacement (82.9%)was higher than that of knee replacement (17.1%).The age (P＝0.005)，the proportion of patients with dementia (P＝0.043)，stroke (P＝0.002)，history of alcohol abuse (P＝0.022)，and fentanyl dosage (P＝0.037)in the delirium group were significantly higher than those in the non-delirium group.In the delirium group，the preoperative total protein level (P＝0.035)and preoperative PaO₂ (P＝0.002)were significantly lower than those in the non-delirium group，while the preoperative indicators and the clinical indicators 1~3 days after surgery showed no statistically significant difference (P＞0.05).Multiple regression analysis revealed that advanced age，history of dementia，alcohol abuse and stroke，preoperative low arterial oxygen partial pressure，postoperative use of opioids and femoral neck fractures were all independent risk factors for delirium after artificial joint replacement.Conclusion femoral neck patients with advanced age，prior history of dementia，alcohol abuse or stroke，and preoperative hypoxemia are of greater risk of postoperative delirium.The surgeon should be alert to the occurrence of this complication early in the operation and communicate well.Optimization of postoperative analgesia project，such as reduction of opioid use，will help reduce delirium.

Key words： artificial joint arthroplasty delirium cognitive disorder risk factors

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	Zhao Liben
	Yang Guojing *
	Zhang Lei

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Zhao Liben,Yang Guojing *,Zhang Lei. Risk Factor Assessment and Clinical Analysis of Delirium after Artificial Joint Replacement[J]. sygkzz, 2019, 25(12): 1077-1088.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2019/V25/I12/1077

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