李敏 刘娣 程向阳

[摘要] 目的 研究老年人工關节置换术患者术后谵妄的影响因素，为有效防治老年患者术后谵妄提供依据。方法 选取蚌埠医学院第一附属医院骨科2018年10月～2019年8月收治的151例人工关节置换术患者作为研究对象。术前采用衰弱量表测定患者衰弱程度，记录患者年龄、性别、焦虑评分（APAIS）、Charlson共病指数（CCI）、日常生活活动能力评分（ADL）、白蛋白水平、美国麻醉学会分级（ASA）等一般资料。根据谵妄量表（CAMCR）筛选出发生术后谵妄的患者，将患者分为谵妄组和非谵妄组，分析术后谵妄影响因素。 结果 谵妄组共37例，非谵妄组共114例。术后谵妄的发生率为24.5%。与非谵妄组比较，谵妄组年龄较大、术前焦虑评分较高、Charlson评分较高、ADL评分较低、术前衰弱人数较多，差异均有统计学意义（均P < 0.05）。二元回归分析显示术前衰弱、焦虑、并存多种疾病、日常活动能力下降是术后谵妄发生的独立影响因素（P < 0.05）。 结论 衰弱、焦虑、并存多种疾病及日常活动能力下降，是老年人工关节置换术患者术后谵妄的独立影响因素。

[关键词] 人工关节置换术;老年患者;术后谵妄;衰弱;危险因素

[中图分类号] R687.4          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0082-04

[Abstract] Objective To study the influence factors of postoperative delirium in olderly patients with artificial joint replacement， so as to provide basis for effective prevention and treatment of postoperative delirium in elderly patients. Methods A total of 151 cases of artificial joint replacement patients undergoing prosthetic replacement surgery at the Department of Orthopedics of the First Affiliated Hospital of Bengbu Medical College from October 2018 to August 2019 were selected as the subjects. The frailty scale was used to measure the frailty of the patients before surgery， and the age， sex， anxiety score （APAIS）， Charlson comorbidities index （CCI）， daily activity score （ADL）， albumin level， American Society of Anesthesiology grading （ASA） and other general data were recorded. Patients with postoperative delirium were screened out according to delirium scale （CAMCR）. The patients were divided into the postoperative delirium group and the non-postoperative delirium group， and risk factors of postoperative delirium were analyzed. Results There were 37 cases in the postoperative delirium group and 114 cases in the non-postoperative delirium group. The incidence of postoperative delirium was 24.5%. Compared with the non-postoperative delirium group， the postoperative delirium group was older， the preoperative anxiety score was higher， the Charlson score was higher， the ADL score was lower， and the numbers of debilitating was more， the differences were statistically significant （all P < 0.05）. Binary regression analysis showed that weakness， anxiety， co-existence of various diseases and decreased ability of daily activities were independent risk factors for postoperative delirium （P < 0.05）. Conclusion Frailty， anxiety， comorbidities and decreased ability of daily activities are independent influence factors for postoperative delirium in elderly patients undergoing artificial joint replacement.

[Key words] Orthopaedic surgery; Elderly patients; Postoperative delirium; Frailty; Influence factors

骨科手术经常发生严重的外科和医疗并发症。术后谵妄（postoperative delirium，POD）是骨科手术患者最常见的并发症之一[1]。POD是指患者在经历外科手术后24～72 h出现的意识、注意力和认知功能的急性紊乱，是常见的老年患者术后并发症[2]。临床医生如不及时恰当地处理，将增加患者的住院时间，导致持续性的认知功能障碍，甚至导致永久性脑损害、痴呆或死亡[3]。本研究通过对151例老年髋关节或膝关节置换术患者的临床资料进行分析，探讨与POD相关的影响因素，为针对性地采用干预措施，降低POD的发生率提供依据，对促进老年患者快速康复具有重要的临床价值。……