| 郭子龙,郝晓芳,杨春燕,等.老年股骨粗隆间骨折患者股骨近端防旋髓内钉内固定术后发生谵妄的危险因素探讨[J].中国临床保健杂志,2023,26(6):795-798. |
| 老年股骨粗隆间骨折患者股骨近端防旋髓内钉内固定术后发生谵妄的危险因素探讨 |
| Risk factors of delirium in elderly patients with intertrochanteric fracture of femur after PFNA internal fixation |
| 投稿时间：2023-05-28 |
| DOI：10.3969/J.issn.1672-6790.2023.06.018 |
| 中文关键词: 股骨骨折 骨折固定术,髓内 谵妄 危险因素 老年人 |
| 英文关键词: Femoral fractures Fracture fixation,intramedullary Delirium Risk factors Aged 〖FL |
| 基金项目:河北省张家口市重点研发计划项目(2121161D) |
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| 中文摘要: |
| 目的 探讨老年股骨粗隆间骨折(IFF)患者股骨近端防旋髓内钉(PFNA)内固定术后发生谵妄的危险因素。方法 选取2019年1月至2021年6月张家口市第一医院行PFNA治疗术后发生谵妄的老年IFF患者50例作为谵妄组,另选取同期术后未发生谵妄老年IFF患者50例作为无谵妄组,比较2组患者的基本资料、围术期情况和病死率情况,使用多因素logistic回归分析PFNA术后谵妄发生危险因素并在此基础上构建危险因素预测模型。结果 老年IFF患者经PFNA内固定术治疗术后固定较好,术后6周、3个月IFF部位恢复良好。谵妄组老年IFF患者中冠心病、高血压、受伤至手术时间≥3 d患者构成比高于无谵妄组(P<0.05)；2组患者30 d病死率比较,差异无统计意义(P>0.05)。谵妄组老年IFF患者中手术时间≥1.5 h、术中出血量≥150 mL、术后低氧血症患者构成比高于无谵妄组(P<0.05),而术前白蛋白≥35 g/L患者构成比低于无谵妄组(P<0.05)。多因素logistic回归分析显示受伤至手术时间≥3 d、手术时间≥1.5 h、术中出血量≥150 mL、术后低氧血症是老年IFF患者PFNA内固定术后发生谵妄独立危险因素(P<0.05)。结论 术后低氧血症、受伤至手术时间和手术时间延长、术中出血量增多会增加老年IFF患者PFNA内固定术后发生谵妄风险。 |
| 英文摘要: |
| Objective To explore the risk factors of delirium in elderly patients with intertrochanteric fracture of femur (IFF) after proximal femoral nail anti-rotation (PFNA) internal fixation.Methods A total of 50 elderly patients with IFF and delirium after PFNA treatment in the Zhangjiakou First Hospital were enrolled as delirium group between January 2019 and June 2021,while other 50 elderly patients without delirium during the same period were enrolled as non-delirium group.The basic data,perioperative conditions and mortality between he two groups were compared.The risk factors of delirium after PFNA were analyzed by multivariate Logistic regression analysis,and the prediction model for risk factors was constructed.Results The fixation effect was better in elderly patients with IFF after PFNA internal fixation,and IFF recovery was good at 6 weeks and 3 months after surgery.The proportions of cases with coronary heart disease,hypertension,and interval from injury to operation ≥3 d in delirium group were higher than those in non-delirium group (P<0.05).There was no significant difference in 30 d mortality rate between the two groups (P>0.05).The proportions of cases with operation time ≥1.5 h,intraoperative blood loss ≥150 mL and postoperative hypoxemia in delirium group were higher than those in non-delirium group (P<0.05),while proportion of cases with albumin ≥35 g/L was lower than that in non-delirium group (P<0.05).Multivariate logistic regression analysis showed that interval from injury to operation ≥3 d,operation time ≥1.5 h,intraoperative blood loss ≥150 mL and postoperative hypoxemia were independent risk factors of delirium in elderly patients with IFF after PFNA internal fixation (P<0.05).Conclusion Postoperative hypoxemia,prolonged interval from injury to operation and operation time,and increased intraoperative blood loss will increase the risk of delirium in elderly patients with IFF after PFNA internal fixation. |
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