老年病人血红蛋白浓度与髋关节置换术后谵妄的相关性

doi:10.3969/j.issn.1003-9198.2024.01.015

摘要/Abstract

摘要： 目的探讨老年髋关节置换病人术后谵妄的危险因素及Hb浓度与术后谵妄的关系。方法纳入2019年6月至2023年1月于牡丹江医学院附属红旗医院行髋关节置换术的年龄≥65岁病人,通过电子病历系统收集病人资料。采用重症监护室意识模糊评估法(CAM-ICU)(中文版)评估病人是否发生术后谵妄。采用多因素Logistic回归分析病人发生术后谵妄的影响因素。建立包含不同影响因素的Logistic回归模型,并绘制ROC曲线分析模型的敏感性。结果共86例病人被纳入分析,其中发生术后谵妄21例,发生率为24.4%。谵妄组与非谵妄组在年龄、术后Hb浓度、围术期Hb浓度变化、是否存在脑部或肺部疾病、疾病类型和Hb浓度下降率方面差异有统计学意义(P<0.05或P<0.01)。多因素Logistic回归分析显示,年龄、是否存在脑部或肺部疾病、术后Hb浓度、围术期Hb浓度变化是老年髋关节置换病人术后谵妄的独立影响因素。不同模型ROC曲线分析显示,术后Hb浓度、围术期Hb浓度变化、年龄及是否伴有脑部或肺部疾病联合预测老年髋关节置换病人发生术后谵妄的AUC最大(AUC=0.916)。结论老年髋关节置换病人围术期不仅要纠正术后低Hb浓度,而且要避免围术期Hb浓度发生较大的变化,以减少术后谵妄的发生。

关键词: 髋关节置换, 术后谵妄, 血红蛋白, 老年人

Abstract: Objective To investigate the risk factors of postoperative delirium in the elderly patients undergoing hip replacement and the relationship between hemoglobin (Hb) concentration and postoperative delirium. Methods The patients aged ≥65 years who underwent hip replacement in Hongqi Hospital Affiliated to Mudanjiang Medical College from June 2019 to January 2023 were enrolled in this study, and the clinical data were collected from the electronic medical record system. Postoperative delirium was assessed by Confusion Assessment Method Intensive Care Unit (CAM-ICU). Multivariate Logistic regression was used to analyze the influencing factors of postoperative delirium. Logistic regression models with different influencing factors were established, and receiver operating characteristic (ROC) curves were drawn to analyze the sensitivity of the models. Results A total of 86 patients were enrolled in the study, including 21 patients with postoperative delirium (24.4%). There were significant differences in age, postoperative Hb concentration, perioperative Hb concentration, combined with brain or lung disease, disease type and the rate of Hb concentration decline between delirium group and non-delirium group (P<0.05 or P<0.01). Multivariate Logistic regression analysis showed that age, combined with brain or lung disease, Hb concentration after surgery and Hb concentration during perioperative period were independent influencing factors for postoperative delirium in the elderly patients undergoing hip replacement. ROC curve analysis of different models showed that the combination of postoperative Hb concentration, perioperative Hb concentration change, age and combined with brain or lung disease to predict postoperative delirium in the elderly patients undergoing hip replacement had the largest area under the curve. Conclusions In the perioperative period of elderly patients undergoing hip replacement, correcting low Hb concentration after surgery and avoiding great change of Hb concentration during perioperative period are important to reduce the occurrence of postoperative delirium.

Key words: hip replacement, postoperative delirium, hemoglobin, aged

中图分类号:

R 749.1

张嘉, 刘鑫伟, 廉洪宇, 刘可鑫, 李子涛. 老年病人血红蛋白浓度与髋关节置换术后谵妄的相关性[J]. 实用老年医学, 2024, 38(1): 64-67.

ZHANG Jia, LIU Xinwei, LIAN Hongyu, LIU Kexin, LI Zitao. Association of hemoglobin concentration with postoperative delirium after hip replacement in elderly patients[J]. Practical Geriatrics, 2024, 38(1): 64-67.

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