术前营养不良的老年病人全麻下髋关节置换术后谵妄的危险因素

doi:10.3969/j.issn.1003-9198.2022.12.005

摘要/Abstract

摘要： 目的探讨术前营养不良的老年病人全麻下髋关节置换术后谵妄(POD)的危险因素。方法选取术前存在营养不良或营养不良风险且在气管插管全麻下行髋关节置换的老年病人149例为研究对象,根据术后是否发生POD分为POD组和非POD组,观察并比较2组相关临床资料。采用多因素Logistic回归分析营养不良老年病人髋关节置换术后发生POD的危险因素。结果 149例病人中60例发生了POD,POD发生率为40.27%。2组在年龄、BMI、低氧血症、电解质紊乱、营养状况、认知功能评分、血清白蛋白、血红蛋白、手术时间、术中出血量以及术后使用镇痛泵等方面差异有统计学意义 (P<0.05)。多因素Logistic回归分析结果提示:年龄≥75岁、BMI<20、微型营养评定法简表评分<7分、MMSE评分<27分及血清白蛋白<30 g/L是术前存在营养不良或营养不良风险的老年病人全麻下行髋关节置换术后发生POD的危险因素(P<0.05),而术后镇痛是保护性因素(P<0.05)。结论术前存在营养不良或营养不良风险老年病人在全麻下行髋关节置换术后POD发生率较高,其与病人的年龄、BMI、营养状况、认知功能、血清白蛋白水平及术后镇痛情况关系密切。

关键词: 营养不良, 全麻, 老年人, 髋关节置换, 术后谵妄, 危险因素

Abstract: Objective To explore the risk factors for postoperative delirium (POD) in the elderly patients with preoperative malnutrition undergoing hip arthroplasty under tracheal intubation and general anesthesia. Methods A total of 149 elderly patients with malnutrition or risk of malnutrition before surgery undergoing hip arthroplasty were selected and divided into the POD group and the non-POD group according to whether they presented with delirium after the operation. The clinical data in two groups were observed and compared. Multivariate Logistic regression analysis was used to analyze the risk factors for POD in the elderly patients with preoperative malnutrition undergoing hip arthroplasty under tracheal intubation and general anesthesia. Results Among 149 patients, POD occurred in 60 patients, and the incidence rate of POD was 40.27%.There were significant differences in age, body mass index(BMI), hypoxemia, electrolyte disturbances, nutritional status, levels of cognitive function score, serum albumin and hemoglobin, length of operation, intraoperative bleeding, postoperative analgesia between the two groups (P<0.05). Multivariate Logistic regression analysis suggested that age ≥75 years, BMI <20, Mini-Nutritional Assessment Short-Form score <7, Mini-Mental State Examination score <27 and serum albumin <30 g/L were the risk factors for POD (P<0.05), and the postoperative analgesia was a protective factor for POD (P<0.05) in the elderly patients with preoperative malnutrition or malnutrition risk undergoing hip arthroplasty under general anesthesia. Conclusions The incidence of POD in the elderly patients with preoperative malnutrition or malnurtition risk undergoing hip arthroplasty under endotracheal intubation and general anesthesia is high. The incidence of POD is closely related to the patients' age, BMI, nutritional status,cognitive function, level of albumin and postoperative analgesia.

Key words: malnutrition, general anesthesia, aged, hip replacement, postoperative delirium, risk factors

中图分类号:

张莹, 胡玉萍, 郭宪, 张利东. 术前营养不良的老年病人全麻下髋关节置换术后谵妄的危险因素[J]. 实用老年医学, 2022, 36(12): 1203-1206.

ZHANG Ying, HU Yu-ping, GUO Xian, ZHANG Li-dong. Risk factors for postoperative delirium in elderly patients with preoperative malnutrition undergoing hip arthroplasty under endotracheal intubation and general anesthesia[J]. Practical Geriatrics, 2022, 36(12): 1203-1206.

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