目的 探讨老年髋部骨折术后患者跌倒恐惧的影响因素，构建个体化风险预测列线图模型并进行临床效能验。方法 采用便利抽样法，选取2025年4月-2025年10月在我院骨科住院并接受手术治疗的老年髋部骨折患者227例作为研究对象。采用一般资料调查表、国际版跌倒效能量表、医院综合焦虑抑郁量表、社会支持评定量表、简易体能状况量表、康复自我效能量表、临床衰弱量表及肌少症筛查问卷等进行横断面调查。采用卡方检验筛选预测变量，多因素Logistic回归分析确定跌倒恐惧的独立影响因素，并基于R语言构建列线图预测模型。通过Bootstrap法进行内部验证，采用校准曲线和受试者工作特征曲线评估模型的区分度与校准度。结果 227例患者中，150例存在跌倒恐惧。多因素Logistic回归分析显示：年龄≥75岁（OR=3.28）、视力不良（OR=6.017）、焦虑抑郁（OR=3.738），衰弱（OR=3.821），肌少症（OR=2.704），康复自我效能低（OR=0.275），为患者发生跌倒恐惧的风险因素。基于上述6个预测因子构建的列线图模型，其ROC曲线下面积为0.839（95%CI：0.832-0.916），。校准曲线显示预测概率与实际发生率一致性良好（Bootstrap验证，P=0.028），DCA结果显示，当阈值概率在0.1-0.9时，该模型净收益优于假设所有患者均接受或均不接受治疗的策略。结论 本研究构建的列线图模型能有效预测老年髋部骨折术后患者发生跌倒恐惧的风险，有助于临床医护人员早期识别高危人群并进行多维度靶向干预。

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。

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．

目的 探讨老年髋部骨折（GHF）患者围术期隐性失血的影响因素及护理措施。方法 回顾性分析2020年3月—2023年3月我院收治的86例老年GHF患者,所有患者均采取手术治疗,计算所有患者围术期失血量,并收集所有患者的一般资料及围术期相关治疗情况,分析不同一般资料患者围术期隐性失血情况,不同手术方式及麻醉方式围术期隐性失血情况,不同术后处理方式围术期隐性失血情况,随后采取Logistic回归分析老年GHF患者围术期隐性失血的影响因素,最后针对结果制定老年GHF隐性失血的护理措施。结果 不同性别和是否合并冠状动脉粥样硬化、高血压患者围术期隐性失血量比较差异无统计学意义（P>0.05）,不同年龄、合并糖尿病、骨折类型患者围术期隐性失血量比较差异有统计学意义（P<0.05）;不同手术方式、麻醉方式患者围术期隐性失血量比较差异有统计学意义（P<0.05）;不同术后引流、使用肝素情况患者围术期隐性失血量比较差异有统计学意义（P<0.05）;Logistic回归分析结果表明：年龄、合并糖尿病、手术方式、麻醉方式、术后引流、使用肝素都是造成GHF老年患者围术期隐性失血的影响因素（P<0.05）。患者经相关护理后,恢复较佳。结论 老年GHF患者围术期会存在大量隐性失血情况,同时年龄、合并糖尿病、手术方式、麻醉方式、术后引流、使用肝素与围术期隐性失血量密切相关,临床上可采取针对性措施减少GHF患者隐性失血。

Objective To explore the influencing factors and nursing measures of perioperative hidden blood loss in elderly patients with geriatric hip fractures（GHF）．Methods From March 2020 to March 2023,86 elderly patients with GHF admitted to our hospital were selected as the study objects for retrospective analysis．All patients were treated with surgery．The perioperative blood loss of all patients was calculated,general information and perioperative treatment status of all patients were collected,the hidden blood loss of patients with different general information,different surgical and anesthesia methods and different postoperative treatment methods were analyzed．Logistic regression analysis was used to analyze the influencing factors of hidden blood loss of elderly GHF patients during the perioperative period．Nursing measures for hidden blood loss in elderly hip fractures were developed based on the results．Results There was no statistical difference in the amount of perioperative hidden blood loss among patients with different gender,complicated with coronary heart disease and hypertension or not（P>0.05）,but there was statistical difference in the amount of perioperative hidden blood loss among patients with different ages,complicated with diabetes and fracture types（P<0.05）．There was statistically significant difference in the amount of hidden blood loss during the perioperative period among patients with different surgical and anesthesia methods（P<0.05）．There was statistically significant difference in the amount of hidden blood loss during the perioperative period among patients with different postoperative drainage and use of heparin（P<0.05）．The results of Logistic regression analysis showed that age,complicated with diabetes,operation methods,anesthesia methods,postoperative drainage and heparin use were independent risk factors for perioperative hidden blood loss in elderly patients with GHF（P<0.05）．Conclusions There will be a lot of hidden blood loss in the perioperative period of elderly patients with GHF．At the same time,age,complicated with diabetes,operation methods,anesthesia methods,postoperative drainage and heparin use are closely related to the amount of hidden blood loss in the perioperative period．Targeted measures can be taken clinically to reduce the hidden blood loss in patients with GHF．