高龄髋部骨折患者术后谵妄与术前痛阈水平的相关性及处理措施

doi:10.3969/j.issn.1000-8535.2024.06.014

摘要/Abstract

摘要： 目的调查与探讨高龄髋部骨折患者术后谵妄（POD）的发生因素,并提出相关处理对策。方法选取2019年8月—2022年12月择在南阳市中医院独山院区进行手术治疗的高龄髋部骨折患者82例为研究对象,所有患者在术前1 d进行机械痛阈评定,在术后7 d判定患者的POD发生情况,进行POD与术前痛阈水平的相关性分析,并提出相关的处理对策。结果术后7 d,82例患者中发生POD 12例（谵妄组）,占比14.6%,未发生POD 70例（非谵妄组）,占比85.37%。谵妄组的性别、体质指数、骨折类型、骨折至手术时间与非谵妄组对比差异无统计学意义（P>0.05）,谵妄组的年龄、术前血红蛋白水平、术前白蛋白水平与非谵妄组对比差异有统计学意义（P<0.05）。谵妄组的术前1 d的痛阈水平低于非谵妄组（P<0.05）。Spearman分析显示,POD与术前痛阈、年龄、术前血红蛋白、术前白蛋白均存在相关性（P<0.05）。Logistic回归分析显示,术前痛阈、年龄、术前血红蛋白、术前白蛋白等都为导致POD发生的影响因素（P<0.05）,要积极加强预防性护理干预。结论高龄髋部骨折患者POD的发生率较高,患者的术前痛阈、年龄、术前血红蛋白、术前白蛋白等均为导致POD发生的影响因素,要积极加强预防性护理干预。

关键词: 高龄, 髋部骨折, 谵妄, 痛阈, 血红蛋白, 处理对策, 年龄

Abstract: Objective To investigate and explore the factors leading to postoperative delirium（POD）in elderly patients with hip fractures,and to propose relevant handling measures．Methods From August 2019 to December 2022,82 cases of elderly patients with hip fractures who underwent surgical treatment in Nanyang Hospital of Traditional Chinese Medicine Dushan District were selected as the research subjects．All patients underwent mechanical pain threshold assessment 1 day before surgery,and their postoperative delirium were determined 7 days after surgery,followed by correlation analysis,and relevant handling measures were proposed．Results Seven days after surgery,there were 12 patients（delirium group）of POD,accounted for 14.6%,and 70 patients（non delirium group）without POD,accounted or 85.37%．There was no significant difference in genders,body mass index,fracture types and fracture to surgery time compared between the delirium group and the non delirium group（P>0.05）． However,there were significant differences in ages,preoperative hemoglobin levels and preoperative albumin levels compared between the delirium group and the non delirium group（P<0.05）．The pain threshold level of the delirium group on the first day before surgery was significantly lower than that of the non delirium group（P<0.05）．Spearman analysis showed that POD was associated with preoperative pain threshold,ages,preoperative hemoglobin and preoperative albumin levels（P<0.05）．Logistic regression analysis showed that the preoperative pain threshold level,ages,preoperative hemoglobin and preoperative albumin levels were all independent risk factors for the development of POD（P<0.05）,preventive nursing intervention should be actively strengthened．Conclusions The incidence of POD is high in elderly patients with hip fractures．Preoperative pain threshold level,age,preoperative hemoglobin and preoperative albumin levels are all factors that contribute to the occurrence of POD．It is necessary to actively strengthen preventive nursing interventions．

Key words: advanced age, hip fracture, delirium, pain threshold, hemoglobin, handling measures, age

芮苗. 高龄髋部骨折患者术后谵妄与术前痛阈水平的相关性及处理措施[J]. 广州医药, 2024, 55(6): 658-662.

RUI Miao. Correlation between postoperative delirium and preoperative pain threshold level in elderly hip fracture patients and its handling measures[J]. Guangzhou Medical Journal, 2024, 55(6): 658-662.

参考文献

[1] BHUSHAN S,HUANG X,DUAN Y,et al.The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery:A systematic review and meta-analysis[J].Int J Surg,2022(105):106854.
[2] 俄尔曲布,余得水,孙广运,等.超前股神经-坐骨神经阻滞对胫腓骨骨折手术患者术后短期认知功能及镇痛的影响[J].西部医学,2023,35(2):266-271.
[3] 王洁,双鹏展,赵龙彪,等.老年患者髋部骨折修复术后谵妄的危险因素[J].临床麻醉学杂志,2023,39(3):235-240.
[4] KIM C H,YANG J Y,MIN C H,et al.The effect of regional nerve block on perioperative delirium in hip fracture surgery for the elderly:A systematic review and meta-analysis of randomized controlled trials[J].Orthop Traumatol Surg Res,2022,108(1):103151.
[5] 李娟,邹义壮,冯锋,等.谵妄评定方法修订及其信度、效度测试[J].临床精神医学杂志,2003,13(3):147-149.
[6] LEIGHTON R,WATSON J T,GIANNOUDIS P,et al.Healing of fracture nonunions treated with low-intensity pulsed ultrasound(LIPUS):A systematic review and meta-analysis[J].Injury,2017,48(7):1339-1347.
[7] LI T,LI J,YUAN L,et al.Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery:The RAGA randomized trial[J].JAMA,2022,327(1):50-58.
[8] 史青梅,阙红波,王守义,等.持续泵注小剂量右美托咪定联合舒芬太尼对老年下肢骨折手术患者镇痛、炎症反应和认知功能的影响[J].现代生物医学进展,2023,23(6):1105-1109,1120.
[9] 郭凤英,祁双,沈沐,等.高龄髋部骨折病人术后谵妄与术前痛阈水平的关系[J].护理研究,2023,37(7):1251-1254.
[10] THISAYAKORN P,THIPAKORN Y,TANTAVISUT S,et al.Delirium due to hip fracture is associated with activated immune-inflammatory pathways and a reduction in negative immunoregulatory mechanisms[J].BMC Psychiatry,2022,22(1):369.
[11] UYSAL A,ALTıPARMAK B,YAŞAR E,et al.The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery:A randomized controlled trial[J].Ulus Travma Acil Cerrahi Derg,2020,26(1):109-114.
[12] 肖多多,严洁敏,曾惠玲,等.早期护理干预联合五心穴穴位按摩对降低高龄髋部骨折患者围术期谵妄发生率的效果[J].国际护理学杂志,2023,42(3):440-443.
[13] 田楚伟,朱桓毅,周钧,等.多学科诊疗模式下周五手术对老年髋部骨折患者临床结局的影响[J].中华医学杂志,2023,103(19):1496-1503.
[14] 北京护理学会骨科专业委员会,中华医学会骨科学分会护理学组,中华医学会创伤学分会护理学组.中国老年髋部骨折围手术期护理专家共识(2023)[J].中华创伤骨科杂志,2023,25(5):369-379.
[15] SIEBER F E,NEUFELD K J,GOTTSCHALK A,et al.Effect of depth of sedation in older patients undergoing hip fracture repair on postoperative delirium:The stride randomized clinical trial[J].JAMA Surg,2018,153(11):987-995.
[16] SONG Y,LIU Y,YUAN Y,et al.Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery:A prospective cohort clinical trial[J].EBioMedicine,2021(70):103490.