股骨头坏死全髋置换术后谵妄综合征情况调查及影响因素分析

徐云云; 鲁娟; 黄聪聪; 潘孝云; 薛星河; 王谊

doi:10.16766/j.cnki.issn.1674-4152.003137

股骨头坏死全髋置换术后谵妄综合征情况调查及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003137

温州医科大学附属第二医院骨科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2020KY187

详细信息

通讯作者:
王谊，E-mail: wangyi5588992@126.com

中图分类号: R681.8 R749
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出版历程
- 收稿日期: 2023-02-06
- 网络出版日期: 2023-09-13

Investigation of delirium syndrome after total hip arthroplasty for femoral head necrosis and analysis of influencing factors

Department of Orthopedics, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探究老年患者股骨头坏死全髋置换术后谵妄综合征及其影响因素，为临床制定针对性预防干预措施提供理论参考。方法选择2020年1月—2022年5月于温州医科大学附属第二医院骨科行全髋置换术治疗的194例老年股骨头坏死患者为观察对象，通过自制调查量表采集患者临床资料，并经意识模糊评估量表(CAM)调查患者是否发生谵妄综合征，调查谵妄综合征发生率，采用多因素logistic回归法分析老年患者股骨头坏死全髋置换术后并发谵妄综合征的影响因素。结果 194例老年股骨头坏死患者全髋置换术后发生谵妄综合征者有26例，发生率为13.40%；有谵妄综合征组、无谵妄综合征组患者在年龄、肺部疾病、夜间睡眠障碍、营养障碍、麻醉方式、手术操作时间、术中机体出血量、术后机体VAS评分、术后血清CRP水平、术后低氧血症发生率方面对比，差异均有统计学意义(均P＜0.05)；多因素logistic分析显示，高龄、肺部疾病、夜间睡眠障碍、营养障碍、麻醉方式(全麻)、手术操作时间长、术中机体出血量多、术后机体VAS评分≥7分、术后血清CRP水平增高、术后低氧血症是老年股骨头坏死患者全髋置换术后谵妄综合征发生的影响因素(均P＜0.05)。结论老年股骨头坏死患者受年龄、肺部疾病、睡眠障碍、机体营养水平等因素影响，全髋置换术后存在较高的谵妄风险，临床应提供针对性预防干预，以降低患者术后并发谵妄综合征的风险。
- 老年 /
- 股骨头坏死 /
- 全髋置换术 /
- 谵妄综合征 /
- 影响因素 /
- 预防干预措施
Abstract: Objective To explore the delirium syndrome after total hip replacement in elderly patients with femoral head necrosis and its influencing factors, and to provide theoretical reference for clinical development of targeted preventive interventions. Methods A total of 194 cases of elderly patients with femoral head necrosis who underwent total hip replacement in the Department of Orthopedics, the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to May 2022 were selected as the observation subjects. The clinical data of patients were collected by self-made survey scale, and the occurrence of delirium syndrome was investigated by the Fuzzy consciousness assessment method (CAM) and the incidence of delirium syndrome was investigated. Multivariate logistic regression was used to analyze the influencing factors of delirium syndrome after total hip replacement in elderly patients with femoral head necrosis. Results There were 26 cases of delirium syndrome after total hip replacement in 194 elderly patients with femoral head necrosis, the incidence was 13.40%. There were differences in age, pulmonary disease, nocturnal sleep disorder, nutritional disorder, anesthesia method, operation time, intraoperative blood loss, postoperative VAS score, postoperative serum CRP level, and postoperative hypoxemia incidence between patients with and without delirium syndrome (all P < 0.05). Multivariate logistic analysis found that advanced age, pulmonary diseases, nocturnal sleep disorders, nutritional disorders, anesthesia method (general anesthesia), long operation time, large amount of intraoperative blood loss, postoperative VAS score ≥7, postoperative serum CRP level increased, and postoperative hypoxemia were the influencing factors for the occurrence of delirium syndrome after total hip replacement in elderly patients with femoral head necrosis (all P < 0.05). Conclusion Elderly patients with femoral head necrosis are affected by age, lung disease, sleep disorder, nutritional level and other factors, and there is a high risk of delirium after total hip replacement. Clinical preventive interventions should be provided to reduce the risk of postoperative delirium syndrome.
- The aged /
- Femoral head necrosis /
- Total hip replacement /
- Delirium syndrome /
- Influencing factors /
- Preventive interventions

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表 1 老年股骨头坏死患者全髋置换术后谵妄综合征发生影响因素的单因素分析[例(%)]

Table 1. Univariate analysis of influencing factors of delirium syndrome after total hip replacement in elderly patients with femoral head necrosis[cases(%)]

因素	有谵妄综合征组 (n=26)	无谵妄综合征组 (n=168)	χ²值	P值	因素	有谵妄综合征组 (n=26)	无谵妄综合征组 (n=168)	χ²值	P值
性别			0.255	0.614	营养障碍			6.947	0.008
女性	11(42.31)	80(47.62)			有	10(38.46)	25(14.88)
男性	15(57.69)	88(52.38)			无	16(61.54)	143(85.12)
年龄(岁)			21.041	< 0.001	麻醉方式			5.965	0.015
≥65	20(76.92)	51(30.36)			全身麻醉	17(65.38)	67(39.88)
＜65	6(23.08)	117(69.64)			非全身麻醉	9(34.62)	101(60.12)
疾病类型			2.136	0.545	手术操作时间(min)			4.586	0.032
药物性股骨头坏死	12(46.15)	77(45.83)			≥60	15(57.69)	60(35.71)
放射术后股骨头坏死	0	2(1.19)			＜60	11(42.31)	108(64.29)
酒精性股骨头坏死	13(50.00)	88(52.38)			术中机体出血量(mL)			4.264	0.039
减压病	1(3.85)	1(0.60)			≥250	10(38.46)	34(20.24)
Ficat分期			0.967	0.326	＜250	16(61.54)	134(79.76)
Ⅲ期	8(30.77)	37(22.02)			术后VAS评分≥7分			15.280	< 0.001
Ⅳ期	18(69.23)	131(77.98)			是	15(57.69)	36(21.43)
酗酒			0.289	0.592	否	11(42.31)	132(78.57)
是	5(19.23)	22(13.10)			术后全血Hb水平(g/L)			0.286	0.593
否	21(80.77)	146(86.90)			＜110	14(53.85)	81(48.21)
基础疾病					≥110	12(46.15)	87(51.79)
肺部疾病	14(53.85)	54(32.14)	4.659	0.031	术后血清CRP水平(mg/L)			5.448	0.020
高血压	15(57.69)	101(60.12)	0.055	0.814	＞10	15(57.69)	57(33.93)
糖尿病	7(26.92)	37(22.02)	0.308	0.579	≤10	11(42.31)	111(66.07)
冠心病	14(53.85)	96(57.14)	0.100	0.652	术后全血红细胞比容(%)			1.577	0.209
焦虑			0.134	0.714	＜37	7(26.92)	25(14.88)
是	6(23.08)	30(17.86)			≥37	19(73.08)	143(85.12)
否	20(76.92)	138(82.14)			术后低氧血症			6.812	0.009
抑郁			0.265	0.607	有	8(30.77)	17(10.12)
是	5(19.23)	40(23.81)			无	18(69.23)	151(89.88)
否	21(80.77)	128(76.19)
夜间睡眠障碍			5.934	0.015
有	10(38.46)	27(16.07)
无	16(61.54)	141(83.93)

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表 2 自变量赋值情况

Table 2. Assignment of independent variables

自变量	赋值方法
年龄	≥65岁=0，＜65岁=1
肺部疾病	有=0，无=1
夜间睡眠障碍	有=0，无=1
营养障碍	有=0，无=1
麻醉方式	全身麻醉=0，非全身麻醉=1
手术操作时间	≥60 min=0，＜60 min=1
术中机体出血量	≥250 mL=0，＜250 mL=1
术后机体VAS评分≥7分	是=0，否=1
术后血清CRP水平	＞10 mg/L=0，≤10 mg/L=1
术后低氧血症	有=0，无=1

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表 3 老年股骨头坏死全髋置换术后谵妄综合征发生影响因素的多因素logistic分析

Table 3. Multivariate logistic analysis of influencing factors of delirium syndrome after total hip replacement in elderly patients with femoral head necrosis

因素	B	SE	Wald χ²	P值	OR(95% CI)
年龄	2.034	0.495	16.904	< 0.001	7.647(2.900~20.168)
肺部疾病	0.901	0.427	4.463	0.035	2.463(1.067~5.684)
夜间睡眠障碍	1.183	0.455	6.772	0.009	3.264(1.339~7.955)
营养障碍	1.274	0.458	7.747	0.005	3.565(1.458~8.767)
麻醉方式	1.046	0.441	5.622	0.018	2.847(1.199~6.762)
手术操作时间	0.898	0.428	4.394	0.036	2.455(1.060~5.683)
术中机体出血量	0.901	0.447	4.076	0.043	2.463(1.027~5.910)
术后机体VAS评分≥7分	1.609	0.439	13.426	< 0.001	5.000(2.114~11.826)
术后血清CRP水平	0.977	0.429	5.180	0.023	2.656(1.145~6.157)
术后低氧血症	1.373	0.496	7.665	0.006	3.948(1.493~10.436)

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