本文選題：高齡 + 術后譫妄　； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:術后譫妄是老年髖部骨折術后最常見的并發(fā)癥之一,嚴重影響患者的生活質(zhì)量和生命健康,給社會造成了巨大的經(jīng)濟負擔。本研究通過探究老年髖部骨折患者術后譫妄的風險因素,明確術后譫妄的高危人群,進而有針對性地預防譫妄,以達到減少譫妄發(fā)生率,促進患者早日康復,減輕社會負擔。方法:納入2015年2月至2016年8月期間,在吉林大學中日聯(lián)誼醫(yī)院骨科收治的老年髖部骨折患者240例。術前1天及術后1、2、3天密切觀察患者,收集患者的一般資料,包括年齡、身高、體重、麻醉方式、手術時間、既往心血管病史等。將患者隨機分為兩組,FTS組在專業(yè)醫(yī)生及麻醉師的指導下,患者術前2h給予不含酒精,含少許糖的透明液體,如茶、清水、咖啡等,術前6h給予易消化食物,術前8h可正常進食。傳統(tǒng)組患者,術前常規(guī)禁食12h,禁飲4h。其他圍手術期措施相同。所有患者均與術前1d由同一研究者采用簡易精神狀態(tài)量表檢查、評估患者有無老年癡呆,認知功能損害的存在。對于譫妄的診斷,需分為兩個步驟:先采用鎮(zhèn)靜深度量表(RASS),評估患者的鎮(zhèn)靜深度;再使用重癥監(jiān)護譫妄評估方法(CAM-ICU)評估譫妄。計算患者的體質(zhì)指數(shù)(body mass index,BMI),參照WHO亞洲人BMI分級標準,將BMI分5個等級,分別賦值,并輸入數(shù)據(jù)庫。將患者的年齡、身高、體重、BMI、等待手術時間、手術時間等進行單因素分析,組間計量資料采用t檢驗,以α=0.05為標準,P0.05為差異具有統(tǒng)計學意義。最后將單因素分析證實差異有統(tǒng)計學意義的自變量,帶入Logistic回歸模型進行多因素分析。結果:1、FTS組術后譫妄的發(fā)病率為6.67%,而傳統(tǒng)組發(fā)生率為20.83%,FTS組譫妄發(fā)生率明顯小于傳統(tǒng)組。結果顯示:禁食禁飲在POD的發(fā)生率上差異有顯著統(tǒng)計學意義(p0.05)。2、傳統(tǒng)組POD組與非POD組進行單因素分析顯示兩組間年齡(x2=12.019,P0.05)、飲酒(x2=19.407,P0.05)、待術時間(x2=20.454,P0.05)、糖尿病(x2=24.569,P0.05)、BMI(t=2.107,P0.05)、手術時間(t=-6.516,P0.05)比較差異有統(tǒng)計學意義。多因素Logistic回歸分析表明:年齡70~80歲組和年齡80歲組發(fā)生POD的風險分別是年齡70歲的7.720倍和8.339倍(95%CI分別為1.174~50.762和1.036~67.140);BMI偏瘦組患者發(fā)生POD的風險是BMI正常組患者的13.791倍(95%CI 1.359~139.979);飲酒≥3次/周的患者發(fā)生POD的風險是飲酒3次/周患者的7.120倍(95%CI 1.299~39.015);糖尿病組患者發(fā)生POD的風險是無糖尿病患者的9.180倍(95%CI 1.810~46.545);手術時間≥180min組患者發(fā)生POD的風險是手術180min組患者的11.559倍(95%CI1.741~76.728);等待手術時間≥7d的患者發(fā)生POD風險是待術時間1~7d組的14.943倍(95%CI 2.646~84.384)。結論:1、本研究證實了:盡可能縮短術前禁食禁飲時間可以降低譫妄發(fā)生率,有利于患者術后恢復,縮短住院時間。2、本研究證實:高齡、偏瘦、糖尿病、飲酒、手術時間、待術時間是術后譫妄的獨立危險因素。各因素對預測術后譫妄均有一定的價值,預測準確性大小依次為:手術時間糖尿病飲酒年齡BMI待術時間。3、本研究證實:麻醉方式、吸煙與術后譫妄并無顯著相關性。
[Abstract]:Objective: postoperative delirium is one of the most common complications after hip fracture in the elderly, which seriously affects the quality of life and life and health of the patients. The risk factors for postoperative delirium in the elderly hip fracture patients are explored, and the high-risk population of postoperative delirium is clearly defined and then targeted prevention is made. Delirium was used to reduce the incidence of delirium, promote early recovery and reduce social burden. Methods: from February 2015 to August 2016, 240 patients with hip fractures in the Department of orthopedics, China Japan Friendship Hospital, Jilin University, were admitted to the Department of orthopedics at the Jilin University China Japan Friendship Hospital. The patients were closely observed and collected at 1 days before and after the operation, and the general data of the patients were collected, including age and height. The patients were divided into two groups randomly. The patients were divided into two groups randomly. Under the guidance of professional doctors and anesthesiologists, group FTS was given a transparent liquid containing a few sugar, such as tea, water, coffee, and so on before operation 2H. Before operation, 6h was given to digestible food, and before the operation, 8h could be eaten normally. The other perioperative measures for 12h and 4h. were the same. All patients with preoperative 1D were examined by the same researcher with a simple mental state scale to assess the presence of dementia and cognitive impairment. The diagnosis of delirium should be divided into two steps: using a sedative depth scale (RASS) to assess the sedative depth of the patient. The CAM-ICU (body mass index, BMI) was used to evaluate the patient's body mass index (BMI). According to the WHO Asians' BMI grading standard, BMI was divided into 5 grades, assigned respectively, and entered the database. The patient's age, height, weight, BMI, waiting for operation time, and operation time were analyzed by single factor analysis. The data were measured with t test, with alpha =0.05 as the standard, P0.05 was statistically significant. Finally, a single factor analysis was used to confirm the statistically significant independent variables and into the Logistic regression model for multiple factors analysis. Results: 1, the incidence of postoperative delirium in group FTS was 6.67%, while the incidence of traditional group was 20.83%, and the incidence of delirium in group FTS was clear. The results showed that the difference in the incidence of POD was statistically significant (P0.05).2. The single factor analysis of the traditional group POD group and non POD group showed the age of two groups (x2=12.019, P0.05), drinking (x2=19.407, P0.05), the operation time (x2=20.454, P0.05), diabetes mellitus (x2=24.569,), surgery Time (t=-6.516, P0.05) was statistically significant. Multiple factor Logistic regression analysis showed that the risk of POD in age 70~80 and age 80 year group was 7.720 times and 8.339 times of age 70 (95%CI respectively 1.174~50.762 and 1.036~67.140), and the risk of POD in patients with BMI thinner group was 13.791 times (95). %CI 1.359~139.979); the risk of POD was 7.120 times as high as 3 times per week for patients who drank more than 3 times / week (95%CI 1.299~39.015); the risk of POD in the diabetic group was 9.180 times (95%CI 1.810~46.545) without diabetes; the risk of POD in patients with surgery longer than 180min was 11.559 times the 180min group (95%CI1.) (95%CI1.). 741~76.728); the risk of POD in patients waiting for more than 7d was 14.943 times as high as that of group 1~7d (95%CI 2.646~84.384). Conclusion: 1. This study confirmed that the reduction of delirium by reducing the time of pre operation prohibition and drinking can reduce the incidence of delirium, which is beneficial to postoperative recovery and shorten the duration of hospitalization. This study confirms that age, lean, diabetes, Alcohol, operation time and time were independent risk factors for postoperative delirium. All factors had certain value in predicting postoperative delirium, and the accuracy of prediction was in the order of operation time of diabetes drinking age of BMI for.3. This study confirmed that there was no significant correlation between smoking and postoperative delirium.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.6

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