老年髋部骨折患者术后谵妄的危险因素分析及护理策略
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摘要
目的探讨老年髋部骨折患者术后谵妄的危险因素及护理对策。方法选择衢州市人民医院2016年1月—2018年9月间收治的74例老年髋部骨折术后谵妄的患者为谵妄组,198例老年髋部骨折术后未发生谵妄的患者为未谵妄组。对2组患者性别、既往谵妄病史、入院前使用抗精神病药物、助听器使用、骨折类型、术前准备不充分、吸入麻醉、手术时间、术后有无低氧血症、术后发生剧烈疼痛等情况进行统计,并采用单因素和多因素分析确定老年髋部骨折患者术后谵妄的危险因素。结果单因素显示既往谵妄病史、入院前使用抗精神病药物、助听器使用、骨折类型、术前准备不充分、吸入麻醉、手术时间长、术后有低氧血症、术后发生剧烈疼痛是老年髋部骨折患者术后谵妄的危险因素。多因素logistic回归分析结果显示:既往谵妄病史、入院前使用抗精神病药物、助听器使用、骨折类型、术前准备不充分、吸入麻醉、手术时间长、术后有低氧血症、术后发生剧烈疼痛是老年髋部骨折患者术后谵妄的独立危险因素。结论既往谵妄病史、入院前使用抗精神病药物、助听器使用、骨折类型、术前准备不充分、吸入麻醉、手术时间长、术后有低氧血症、术后发生剧烈疼痛是老年髋部骨折患者术后谵妄的危险因素,临床中要重视危险因素,做好治疗和护理,预防术后谵妄的发生。
Objective To investigate the risk factors of postoperative delirium in elderly patients with hip fracture and the nursing strategies. Methods Seventy-four patients with postoperative hip fractures who underwent senile hip fracture between January 2016 and September 2018 were enrolled in the sputum group. One hundred and ninety-eight patients who had no sputum after hip fracture in the elderly were the sputum group. Two groups of gender, previous history of rickets, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, operation time, postoperative hypoxemia, severe pain after surgery The situation was statistically analyzed, and single factor and multivariate analysis were used to determine the risk factors for postoperative delirium in elderly patients with hip fracture. Results Univariate results showed that previous history of sputum, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, and presence or absence of hypoxia after surgery hypertension and severe postoperative pain were risk factors for postoperative delirium in elderly patients with hip fracture. Multivariate logistic regression analysis showed that previous history of sputum, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, and presence or absence of hypoxia after surgery hypertension and severe postoperative pain were risk factors for postoperative delirium in elderly patients with hip fracture. Conclusion The previous history of rickets, use of antipsychotics before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, postoperative hypoxemia, postoperative severe pain is elderly hip Risk factors for postoperative delirium in patients with fractures, risk factors should be emphasized in the clinic, and treatment and care should be done to prevent postoperative delirium.
Objective To investigate the risk factors of postoperative delirium in elderly patients with hip fracture and the nursing strategies. Methods Seventy-four patients with postoperative hip fractures who underwent senile hip fracture between January 2016 and September 2018 were enrolled in the sputum group. One hundred and ninety-eight patients who had no sputum after hip fracture in the elderly were the sputum group. Two groups of gender, previous history of rickets, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, operation time, postoperative hypoxemia, severe pain after surgery The situation was statistically analyzed, and single factor and multivariate analysis were used to determine the risk factors for postoperative delirium in elderly patients with hip fracture. Results Univariate results showed that previous history of sputum, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, and presence or absence of hypoxia after surgery hypertension and severe postoperative pain were risk factors for postoperative delirium in elderly patients with hip fracture. Multivariate logistic regression analysis showed that previous history of sputum, use of antipsychotic drugs before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, and presence or absence of hypoxia after surgery hypertension and severe postoperative pain were risk factors for postoperative delirium in elderly patients with hip fracture. Conclusion The previous history of rickets, use of antipsychotics before admission, use of hearing aids, type of fracture, inadequate preoperative preparation, inhalation anesthesia, time of surgery, postoperative hypoxemia, postoperative severe pain is elderly hip Risk factors for postoperative delirium in patients with fractures, risk factors should be emphasized in the clinic, and treatment and care should be done to prevent postoperative delirium.
引文
[1] 真启云,谢军,庞剑剑,等.老年髋部骨折患者围手术期谵妄管理方案的实施及效果评价[J].中华护理杂志,2017,52(9):1068-1072.
[2] 梁玉柱,郭洪刚.老年骨质疏松性髋部骨折:昨天、今天及未来[J].中国组织工程研究,2017,21(15):2438-2443.
[3] 中国老年医学学会骨与关节分会创伤骨科学术工作委员会.老年髋部骨折诊疗专家共识(2017)[J].中华创伤骨科杂志,2017,19(11):921-927.
[4] 吁英,方禹佳,汤洁,等.中文版CAM-ICU量表评估ICU谵妄的效果探讨[J].现代医院,2016,16(8):1195-1197.
[5] 霍妍,彭贵凌,刘静曦,等.综合护理干预预防老年髋部骨折患者术后谵妄[J].护理学杂志,2017,32(20):9-12.
[6] 卢文宁,高德伟,王蓉,等.老年骨折患者谵妄的发生率及危险因素分析[J].中华老年心脑血管病杂志,2017,19(12):1291-1294.
[7] CAPE E,HALL R J,VAN MUNSTER B C,et al.Cerebrospinal:fluid markers of neuroinflammation in delirium:a role- for interleukin-1β in deliriumafterhipfracture[J].J Psychosom Res,2014,77(3):219-225.
[8] 刘佩佩,宋慧,李小磊,等.老年髋关节骨折术后谵妄发生的影响因素[J].江苏医药,2017,43(23):1698-1701.
[9] 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.
[10] 龚健,罗程,冯志杰,等.高龄髋部骨折患者术后急性意识障碍的危险因素及防治对策[J].中国医药导报,2017,14(36):80-83.
[11] 鲍宏玮,严力生,陈红梅,等.麻醉选择对老年人髋部骨折术后谵妄的影响[J].中国骨与关节损伤杂志,2016,31(4):393-394.
[12] 李强,李元,李辉,等.高龄患者髋部骨折术后意识障碍原因分析及干预[J].疾病监测与控制,2018,12(2):101-104.
[13] 史露玉.老年髋部骨折术后谵妄的相关因素分析及护理对策[J].全科护理,2014,12(27):2546-2547.
[14] 窦东梅,张永乐,李瑞玲.不同术式对高龄髋部骨折患者术后发生谵妄的影响[J].中国老年学杂志,2014,34(4):1088-1089.
[15] 诸葛军,熊良平.老年髋部骨折术后谵忘的危险因素分析[J].浙江临床医学,2016,18(8):1463-1464.
[16] 吕阳,刘启宇,刘军,等.中国老年髋部骨折患者术后发生谵妄相关因素的Meta分析[J].中国组织工程研究,2018,22(15):2437-2445.
[17] 刘思景,郑臣校,曾远,等.老年转子间骨折PFNA内固定术后谵妄状态的危险因素分析[J].泰山医学院学报,2018,39(5):543-545.
[18] 李志,刘洋,黄富国.90岁以上老龄股骨颈骨折患者死亡相关危险因素分析[J].中国修复重建外科杂志,2018,32(8):1102-1104.
[19] 胡玲,胡三莲,钱会娟,等.老年髋部骨折患者术后发生谵妄的危险因素现况[J].解放军护理杂志,2018,35(22):44-47.
[20] 邓敏鑫,卢仲明,李韵娴,等.窄带成像内镜检查在喉癌和癌前病变诊断中的应用[J].中国耳鼻咽喉头颈外科,2018,25(12):635-638.
[2] 梁玉柱,郭洪刚.老年骨质疏松性髋部骨折:昨天、今天及未来[J].中国组织工程研究,2017,21(15):2438-2443.
[3] 中国老年医学学会骨与关节分会创伤骨科学术工作委员会.老年髋部骨折诊疗专家共识(2017)[J].中华创伤骨科杂志,2017,19(11):921-927.
[4] 吁英,方禹佳,汤洁,等.中文版CAM-ICU量表评估ICU谵妄的效果探讨[J].现代医院,2016,16(8):1195-1197.
[5] 霍妍,彭贵凌,刘静曦,等.综合护理干预预防老年髋部骨折患者术后谵妄[J].护理学杂志,2017,32(20):9-12.
[6] 卢文宁,高德伟,王蓉,等.老年骨折患者谵妄的发生率及危险因素分析[J].中华老年心脑血管病杂志,2017,19(12):1291-1294.
[7] CAPE E,HALL R J,VAN MUNSTER B C,et al.Cerebrospinal:fluid markers of neuroinflammation in delirium:a role- for interleukin-1β in deliriumafterhipfracture[J].J Psychosom Res,2014,77(3):219-225.
[8] 刘佩佩,宋慧,李小磊,等.老年髋关节骨折术后谵妄发生的影响因素[J].江苏医药,2017,43(23):1698-1701.
[9] 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.
[10] 龚健,罗程,冯志杰,等.高龄髋部骨折患者术后急性意识障碍的危险因素及防治对策[J].中国医药导报,2017,14(36):80-83.
[11] 鲍宏玮,严力生,陈红梅,等.麻醉选择对老年人髋部骨折术后谵妄的影响[J].中国骨与关节损伤杂志,2016,31(4):393-394.
[12] 李强,李元,李辉,等.高龄患者髋部骨折术后意识障碍原因分析及干预[J].疾病监测与控制,2018,12(2):101-104.
[13] 史露玉.老年髋部骨折术后谵妄的相关因素分析及护理对策[J].全科护理,2014,12(27):2546-2547.
[14] 窦东梅,张永乐,李瑞玲.不同术式对高龄髋部骨折患者术后发生谵妄的影响[J].中国老年学杂志,2014,34(4):1088-1089.
[15] 诸葛军,熊良平.老年髋部骨折术后谵忘的危险因素分析[J].浙江临床医学,2016,18(8):1463-1464.
[16] 吕阳,刘启宇,刘军,等.中国老年髋部骨折患者术后发生谵妄相关因素的Meta分析[J].中国组织工程研究,2018,22(15):2437-2445.
[17] 刘思景,郑臣校,曾远,等.老年转子间骨折PFNA内固定术后谵妄状态的危险因素分析[J].泰山医学院学报,2018,39(5):543-545.
[18] 李志,刘洋,黄富国.90岁以上老龄股骨颈骨折患者死亡相关危险因素分析[J].中国修复重建外科杂志,2018,32(8):1102-1104.
[19] 胡玲,胡三莲,钱会娟,等.老年髋部骨折患者术后发生谵妄的危险因素现况[J].解放军护理杂志,2018,35(22):44-47.
[20] 邓敏鑫,卢仲明,李韵娴,等.窄带成像内镜检查在喉癌和癌前病变诊断中的应用[J].中国耳鼻咽喉头颈外科,2018,25(12):635-638.