外科Apgar评分对股骨粗隆间骨折PFNA内固定术后谵妄的预测价值
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摘要
目的分析股骨粗隆间骨折股骨近端防旋髓内钉(PFNA)内固定术后谵妄发生的危险因素,并探讨外科Apgar评分对术后谵妄的预测价值。方法纳入自2013-01—2017-05行PFNA内固定手术治疗的158例股骨粗隆间骨折。将术后发生谵妄的患者纳入谵妄组,未发生谵妄的患者纳入无谵妄组。采用单因素分析和多因素Logistic回归分析确定术后谵妄发生的危险因素,并绘制外科Apgar评分预测术后谵妄的ROC曲线。结果 49例(31.0%)术后出现谵妄。多因素Logistic回归分析结果发现,冠心病是术后谵妄发生的独立危险因素,而男性、高外科Apgar评分者谵妄发生率低。ROC分析结果发现,外科Apgar评分预测术后谵妄发生的曲线下面积为0.628,临界值为6分,外科Apgar评分≤6分预测术后谵妄的敏感度为0.55(95%CI为0.40～0.69),特异性为0.63(95%CI为0.54～0.72)。结论术中低外科Apgar评分是股骨粗隆间骨折PFNA内固定术后谵妄发生的独立危险因素,外科Apgar评分≤6分对于术后谵妄发生具有预测价值,但灵敏度和特异性不高。
Objective To investigate the risk factors for postoperative delirium after proximal femoral nail antirotation(PFNA)internal fixation for femoral intertrochanteric fractures and the predicting values of surgical Apgar score(SAS) for postoperative delirium. Methods A total of 158 patients undergoing PFNA internal fixation for femoral intertrochanteric fracture from January 2013 to May 2017 were included. The patients were divided into delirium group and non-delirium group based on whether postoperative delirium occurred or not. Univariate analysis and multivariate Logistic regression modeling were employed to detect the risk factors for postoperative delirium. Receiver operating characteristic curve(ROC) was further plotted to demonstrate the power for SAS in predicting postoperative delirium. Results Forty-nine cases(31.0%) were confirmed with postoperative delirium. Multivariate Logistic regression analysis found coronary heart disease as an independent risk factor for postoperative delirium. Males and higher SAS values were related with less postoperative delirium. ROC test found that the area under curve was 0.628 and the optimal cut-off was 6. The sensitivity was 0.55(95%CI was 0.40-0.69) and the specificity was 0.63(95%CI was 0.54-0.72) for SAS ≤6. Conclusion Intraoperative low SAS values is an independent risk factor for postoperative delirium in femoral intertrochanteric fracture patients accepting PFNA internal fixation surgery.SAS ≤6 is useful in predicting postoperative delirium but with low sensitivity and specificity.
Objective To investigate the risk factors for postoperative delirium after proximal femoral nail antirotation(PFNA)internal fixation for femoral intertrochanteric fractures and the predicting values of surgical Apgar score(SAS) for postoperative delirium. Methods A total of 158 patients undergoing PFNA internal fixation for femoral intertrochanteric fracture from January 2013 to May 2017 were included. The patients were divided into delirium group and non-delirium group based on whether postoperative delirium occurred or not. Univariate analysis and multivariate Logistic regression modeling were employed to detect the risk factors for postoperative delirium. Receiver operating characteristic curve(ROC) was further plotted to demonstrate the power for SAS in predicting postoperative delirium. Results Forty-nine cases(31.0%) were confirmed with postoperative delirium. Multivariate Logistic regression analysis found coronary heart disease as an independent risk factor for postoperative delirium. Males and higher SAS values were related with less postoperative delirium. ROC test found that the area under curve was 0.628 and the optimal cut-off was 6. The sensitivity was 0.55(95%CI was 0.40-0.69) and the specificity was 0.63(95%CI was 0.54-0.72) for SAS ≤6. Conclusion Intraoperative low SAS values is an independent risk factor for postoperative delirium in femoral intertrochanteric fracture patients accepting PFNA internal fixation surgery.SAS ≤6 is useful in predicting postoperative delirium but with low sensitivity and specificity.
引文
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[9] Guo Y,Jia P,Zhang J,et al. Prevalence and risk factors of postoper-ative delirium in elderly hip fracture patients[J]. J Int Med Res,2016,44(2):317-327.
[10] Wang J,Li Z,Yu Y,et al. Risk factors contributing to postoperativedelirium in geriatric patients postorthopedic surgery[J]. Asia PacPsychiatry,2015,7(4):375-382.
[11] Ernst G,Watne LO,Frihagen F,et al. Decreases in heart rate vari-ability are associated with postoperative complications in hip frac-ture patients[J]. PLoS One,2017,12(7):e0180423.
[12] Zhang H,Lu Y,Liu M,et al. Strategies for prevention of postopera-tive delirium:a systematic review and meta-analysis of random-ized trials[J]. Crit Care,2013,17(2):R47.
[13]成慧,潘芳.右美托咪定对老年股骨粗隆间骨折患者术后谵妄的影响[J].中国医药,2017,12(8):1231-1234.
[14] Neerland BE,Krogseth M,Juliebo V,et al. Perioperative hemody-namics and risk for delirium and new onset dementia in hip frac-ture patients. A prospective follow-up study[J]. PLoS One,2017,12(7):e0180641.
[15] Freter S,Koller K,Dunbar M,et al. Translating delirium preventionstrategies for elderly adults with hip fracture into routine clinicalcare:a pragmatic clinical trial[J]. J Am Geriatr Soc,2017,65(3):567-573.
[16] Inouye SK,Westendorp RG,Saczynski JS. Delirium in elderly peo-ple[J]. Lancet,2014,383(9920):911-922.
[17]冯旭,陈辉,蔡宁宇,等.老年髋部骨折患者术后谵妄发生的危险因素分析[J].中国骨与关节损伤杂志,2017,32(2):113-116.
[18] Oh ES,Sieber FE,Leoutsakos JM,et al. Sex differences in hipfracture surgery:preoperative risk factors for delirium and postop-erative outcomes[J]. J Am Geriatr Soc,2016,64(8):1616-1621.
[19] Wang NY,Hirao A,Sieber F. Association between intraoperativeblood pressure and postoperative delirium in elderly hip fracturepatients[J]. PLoS One,2015,10(4):e0123892.
[2] Martocchia A,Curto M,Comite F,et al. The prevention and treat-ment of delirium in elderly patients following hip fracture surgery[J].Recent Pat CNS Drug Discov,2015,10(1):55-64.
[3] Rudolph JL. Delirium after hip fracture:still a problem[J]. AnesthAnalg,2015,121(5):1119-1120.
[4] Smith TO,Cooper A,Peryer G,et al. Factors predicting incidence ofpost-operative delirium in older people following hip fracturesurgery:a systematic review and meta-analysis[J]. Int J GeriatrPsychiatry,2017,32(4):386-396.
[5] Kavouspour C,Wang N,Mears SC,et al. Surgical procedure andpostoperative delirium in geriatric hip fracture patients[J]. Eur JAnaesthesiol,2016,33(3):230.
[6] Gawande AA,Kwaan MR,Regenbogen SE,et al. An Apgar score forsurgery[J]. J Am Coll Surg,2007,204(2):201-208.
[7] Sankar A,Beattie WS,Wijeysundera DN. How can we identify thehigh-risk patient?[J]. Curr Opin Crit Care,2015,21(4):328-335.
[8] Sakan S,Pavlovic DB,Milosevic M,et al. Implementing the SurgicalApgar Score in patients with trauma hip fracture[J]. Injury,2015,46Suppl 6:S61-66.
[9] Guo Y,Jia P,Zhang J,et al. Prevalence and risk factors of postoper-ative delirium in elderly hip fracture patients[J]. J Int Med Res,2016,44(2):317-327.
[10] Wang J,Li Z,Yu Y,et al. Risk factors contributing to postoperativedelirium in geriatric patients postorthopedic surgery[J]. Asia PacPsychiatry,2015,7(4):375-382.
[11] Ernst G,Watne LO,Frihagen F,et al. Decreases in heart rate vari-ability are associated with postoperative complications in hip frac-ture patients[J]. PLoS One,2017,12(7):e0180423.
[12] Zhang H,Lu Y,Liu M,et al. Strategies for prevention of postopera-tive delirium:a systematic review and meta-analysis of random-ized trials[J]. Crit Care,2013,17(2):R47.
[13]成慧,潘芳.右美托咪定对老年股骨粗隆间骨折患者术后谵妄的影响[J].中国医药,2017,12(8):1231-1234.
[14] Neerland BE,Krogseth M,Juliebo V,et al. Perioperative hemody-namics and risk for delirium and new onset dementia in hip frac-ture patients. A prospective follow-up study[J]. PLoS One,2017,12(7):e0180641.
[15] Freter S,Koller K,Dunbar M,et al. Translating delirium preventionstrategies for elderly adults with hip fracture into routine clinicalcare:a pragmatic clinical trial[J]. J Am Geriatr Soc,2017,65(3):567-573.
[16] Inouye SK,Westendorp RG,Saczynski JS. Delirium in elderly peo-ple[J]. Lancet,2014,383(9920):911-922.
[17]冯旭,陈辉,蔡宁宇,等.老年髋部骨折患者术后谵妄发生的危险因素分析[J].中国骨与关节损伤杂志,2017,32(2):113-116.
[18] Oh ES,Sieber FE,Leoutsakos JM,et al. Sex differences in hipfracture surgery:preoperative risk factors for delirium and postop-erative outcomes[J]. J Am Geriatr Soc,2016,64(8):1616-1621.
[19] Wang NY,Hirao A,Sieber F. Association between intraoperativeblood pressure and postoperative delirium in elderly hip fracturepatients[J]. PLoS One,2015,10(4):e0123892.