90岁以上髋部骨折患者术后发生谵妄的危险因素及预后分析

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Abstract Objective To investigate the incidence of postoperative delirium in hip fracture patients over 90，the risk factors of delirium，and study the influence of delirium on perioperative complications，mortality and walking ability.Methods A retrospective observation study was conducted to analyze the data of hip fracture patients over 90 in the seventh medical center of the General Hospital of the Chinese people's Liberation Army from January 2012 to December 2018.157 patients were divided into delirium group and non delirium group according to whether delirium occurred after operation.There were41 patients in delirium group，including 15 males，26 females，aged 90~104 years old，with an average of (93.17±3.15)years.And there were 116 patients in non delirium group，including 43 males and 73 females，aged 90~102 years old，with an average age of (92.07±2.44)years.The general data，perioperative complications，postoperative mortality and walking ability of the two groups were compared.Results Delirium occurred in 41 patients(26.1%) after operation in over 90 yearship fracture.Delirium mainly occurred within 1-3d after operation，and the duration was mostly within 1 week.The 4or morecomobidities (OR=5.205，95%CI：1.649~16.431；P＝0.005)，time of operation (OR=1.540，95%CI：1.204~1.969；P＝0.001)，general anesthesia (OR=2.463，95%CI：1.852~7.117；P＝0.036) were independent risk factors for delirium after operation.The incidence of cerebrovascular events 3 cases (7.3%)，cardiac adverse events 9 cases(22.0%)，pulmonary infection 13 cases(31.7%) in delirium group were higher than those in non-delirium group (cerebrovascular events，0 cases；10 cases(8.6%)；pulmonary infection，18 cases (15.5%).There werestatistical difference (P＜0.05).The mean lengths of stay in delirium group were (19.19±15.14)days，and those of non-delirium group were (14.77±10.53)d.The difference were statistically significant (t＝2.049，P＝0.042).The mortality of 30 days，1 year and overall mortality in delirium group were 17.1% (7 cases)，43.9%(18 cases) and 56.1%(23 cases)，respectively，which were higher than those of non-delirium group (30 days，4.3%，5 cases；1 year，18.1%，21 cases；overall，34.5%，40 cases)，respectively，which hadstatistical differences (P＜0.05).After adjusting the related confounding factors，delirium was an independent risk factor for 30 days mortality after operation (OR=7.825，95%CI：1.327~46.154；P＝0.023) and 1 year (OR=2.991，95%CI：1.162~1.696；P＝0.023).In the delirium group，23 patients survived at 1 year after operation，only 6(26.1%) could walk independently，14(60.9%) needed auxiliary device，3(13.0%) were in bed；95 patients survived at 1 year after operation，34(35.8%) could walk independently，52(54.7%) needed auxiliary device，9(9.5%) needed to stay in bed.There was no significant difference between the two groups (χ²=0.888，P＝0.641).Conclusion The incidence of postoperative delirium in very elderly patients with hip fracture is high，and the peak was 1-3 days after operation.The 4 or more comorbidities，timeof surgery and general anesthesia are independent risk factors for postoperative delirium.The incidence of perioperative complications (cerebrovascular time，adverse cardiac events and pulmonary infection) and postoperative mortality in delirium patients are high，which are independent risk factors for 30 days and 1 year after operation.

Key words： hip fracture elderly delirium

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	Articles by authors
	Zhao Shengjie 1
	Zheng Huayong 2
	Wang Xiaowei 2*
	Sun Tiansheng 2
	Zhang Jianzheng 2
	Liu zhi 2

Cite this article:

Zhao Shengjie 1,Zheng Huayong 2,Wang Xiaowei 2*, et al. Risk Factors and Prognosis of Postoperative Delirium in Patients Over 90 with Hip Fracture[J]. sygkzz, 2022, 28(1): 20-24.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2022/V28/I1/20

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