老年髋部骨折患者术后发生谵妄的危险因素研究进展
Research Progress on Risk Factors of Postoperative Delirium in Elderly Patients with Hip Fracture
摘要: 术后谵妄是老年髋部手术患者的常见疾病。年龄是术后谵妄的风险因素。在这越来越老龄化的现况下,老年患者手术的比例在逐日增加。其中术后谵妄作为髋关节手术的常见并发症,在患者身体以及心理上带来很大损伤的同时导致患者长期认知功能障碍。术后谵妄是一个多因素问题,需要综合考虑患者的具体情况和围术期护理策略,以降低风险并改善患者的预后。因此术后谵妄的发生及其围手术期相关危险因素仍是我们研究的重点。本综述讨论了老年髋部手术患者术后谵妄的相关危险因素以及术后谵妄的评估以及干预措施。未来的研究致力于有效干预措施降低术后谵妄的风险,改善患者的预后和生活质量。
Abstract: Postoperative delirium is a common disease in elderly patients undergoing hip surgery. As we all know, age is a well-known risk factor. In this increasingly aging situation, the proportion of elderly patients undergoing surgery is increasing day by day. Among them, postoperative delirium is a common complication of hip surgery. It brings great physical and psychological damage to patients and leads to long-term cognitive dysfunction. Postoperative delirium is a multi-factor problem, which requires comprehensive consideration of the patient’s specific situation and perioperative nursing strategies to reduce the risk and improve the prognosis of patients. Therefore, the occur-rence of postoperative delirium and its perioperative related risk factors are still the focus of our research. This review discusses the related risk factors of postoperative delirium in elderly patients undergoing hip surgery, as well as the evaluation and intervention measures of postoperative de-lirium. Future research is devoted to effective interventions to reduce the risk of postoperative de-lirium and improve the prognosis and quality of life of patients.
文章引用:马力亚·阿力木, 麦尔甫哈·克热木, 蔡小丽. 老年髋部骨折患者术后发生谵妄的危险因素研究进展[J]. 临床医学进展, 2024, 14(3): 338-344. https://doi.org/10.12677/ACM.2024.143706

参考文献

[1] Kappenschneider, T., Maderbacher, G., Weber, M., Greimel, F., Holzapfel, D., et al. (2022) Special Orthopaedic Geriat-rics (SOG—A New Multiprofessional Care Model for Elderly Patients in Elective Orthopaedic Surgery: A Study Proto-col for a Prospective Randomized Controlled Trial of a Multimodal Intervention in Frail Patients with Hip and Knee Re-placement. BMC Musculoskeletal Disorders, 23, Article No. 1079. [Google Scholar] [CrossRef] [PubMed]
[2] Zhang, C.G.., Feng, J.N., Wang, S.F., Gao, P., Xu, L., et al. (2020) Incidence of and Trends in Hip Fracture among Adults in Urban China: A Nationwide Retrospective Cohort Study. PLOS Medicine, 17, e1003180. [Google Scholar] [CrossRef] [PubMed]
[3] Watne, L.O., Torbergsen, A.C., Conroy, S., Engedal, K., Fri-hagen, F., Hjorthaug, G.A., Juliebo, V., Raeder, J., Saltvedt, I., Skovlund, E. and Wyller, T.B. (2014) The Effect of A Pre- and Postoperative Orthogeriatric Service on Cognitive Function in Patients with Hip Fracture: Randomized Con-trolled Trial (Oslo Orthogeriatric Trial). BMC Medicine, 12, Article No. 63. [Google Scholar] [CrossRef] [PubMed]
[4] Cedeno-Veloz, B.A., Casadamon-Munarriz, I., Rodríguez-García, A., et al. (2023) Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial. Journal of Clinical Medicine, 13, Article 97. [Google Scholar] [CrossRef] [PubMed]
[5] Jin, Z.S., Hu, J. and Ma, D.Q. (2020) Postoperative Delirium: Perioper-ative Assessment, Risk Reduction, and Management. British Journal of Anaesthesia, 125, 492-504. [Google Scholar] [CrossRef] [PubMed]
[6] 袁建坤, 肖煌怡, 严梓予, 等. 老年髋部骨折全髋关节置换术后超早期康复负重训练最佳证据总结[J]. 中国老年保健医学, 2023, 21(2): 56-60, 64.
[7] Bruce, A.J., Ritchie, C.W., Blizard, R., Lai, R. and Raven, P. (2007) The Incidence of Delirium Associated with Orthopedic Surgery: A Me-ta-Analytic Review. International Psychogeriatrics, 19, 197-214. [Google Scholar] [CrossRef
[8] Magnuson, J.A., Griffin, S.A., Griffin, S.A., Sutton, R.M., Blaber, O., et al. (2023) Revision Total Hip Arthroplasty in Octogenarians Compared with Septuagenarians: Is There a Real Difference? The Journal of Bone and Joint Surgery, 105, 1246-1251. [Google Scholar] [CrossRef
[9] Dovjak, P., Iglseder, B., Mikosch, P., Gosch, M., Muller, E., Pinter, G., et al. (2013). Treatment and Prevention of Postoperative Complications in Hip Fracture Patients: Infections and De-lirium. Wiener MedizinischeWochenschrift, 163, 448-454.[CrossRef] [PubMed]
[10] Oh, S.T. and Park, J.Y. (2019) Postoperative Delirium. Korean Journal of Anesthesiology, 72, 4-12. [Google Scholar] [CrossRef] [PubMed]
[11] Chen, J., Ji, X. and Xing, H. (2022) Risk Factors and a Nomogram Model for Postoperative Delirium in Elderly Gastric Cancer Patients after Laparoscopic Gastrectomy. World Journal of Surgical Oncology, 20, Article No. 319. [Google Scholar] [CrossRef] [PubMed]
[12] 高旗, 孙天培, 武广义. 老年患者术后谵妄的病理生理机制研究进展[J]. 医学研究与教育, 2022, 39(4): 8-13.
[13] Lee, S.J., et al. (2020) Postoperative Delirium after Hip Sur-gery Is a Potential Risk Factor for Incident Dementia: A Systematic Review and Meta-Analysis of Prospective Studies. Archives of Gerontology and Geriatrics, 87, Article ID: 103977. [Google Scholar] [CrossRef] [PubMed]
[14] 文新平, 胡松, 董河, 等. 老年人髋部骨折术后谵妄的研究进展[J]. 中华老年医学杂志, 2020, 39(10): 1219-1222.
[15] Kang, T., et al. (2020) Incidence & Risk Factors of Postoperative Delirium after Spinal Surgery in Older Patients. Scientific Reports, 10, Article No. 9232. [Google Scholar] [CrossRef] [PubMed]
[16] Luo, A.L., Yan, J., Tang, X.L., et al. (2019) Postoperative Cognitive Dysfunction in the Aged: The Collision of Neuroin-flammaging with Perioperative Neuroinflammation. Inflammopharmacology, 27, 27-37. [Google Scholar] [CrossRef] [PubMed]
[17] Kwon, H.S. and Koh, S.H. (2020) Neuroinflammation in Neu-rodegenerative Disorders: The Roles of Microglia and Astrocytes. Translational Neurodegeneration, 9, Article No. 42. [Google Scholar] [CrossRef] [PubMed]
[18] van Gool, W.A., van de Beek, D. and Eikelenboom, P. (2010) Systemic Infection and Delirium: When Cytokines and Acetylcholine Collide. The Lancet, 375, 773-775. [Google Scholar] [CrossRef
[19] Capri, M., Yani, S.L., Chattat, R., et al. (2014) Pre-Operative, High-IL-6 Blood Level Is a Risk Factor of Post-Operative Delirium Onset in Old Patients. Frontiers in Endocrinology, 5, Article 173. [Google Scholar] [CrossRef] [PubMed]
[20] Zhang, W.C., Wang, T.L., Wang, G., Yang, M.H. and Zhou, Y. (2020) Effects of Dexmedetomidine on Postoperative Delirium and Expression of IL-1β, IL-6, and TNF-α in Elderly Patients after Hip Fracture Operation. Frontiers in Pharmacology, 11, Article 678. [Google Scholar] [CrossRef] [PubMed]
[21] Venkatakrishnaiah, N.K., Anandkumar, U.M., Wooly, S., Rajkamal, G., Gadiyar, H.B., et al. (2022) Identification of Factors Contributing to the Development of Postoperative Delirium in Geriatric Patients with Hip Fractures—A Prospective Study. Journal of Family Medicine and Primary Care, 11, 4785-4790. [Google Scholar] [CrossRef] [PubMed]
[22] Juliebo, V., Bjoro, K., Krogseth, M., et al. (2009) Risk Factors for Preoperative and Postoperative Delirium in Elderly Patients with Hip Fracture. Journal of the American Geriatrics Society, 57, 1354-1361. [Google Scholar] [CrossRef] [PubMed]
[23] Pinho, C., Cruz, S., Santos, A., et al. (2016) Postoperative Delirium: Age and Low Functional Reserve as Independent Risk Factors. Journal of Clinical Anesthesia, 33, 507-513. [Google Scholar] [CrossRef] [PubMed]
[24] Li, J., Meng, D.M., Chang, C., Fu, B., Xie, C., et al. (2021) Risk Factors for Delirium after Coronary Artery Bypass Grafting in Elderly Patients. Annals of Translational Medicine, 9, Article 1666. [Google Scholar] [CrossRef] [PubMed]
[25] 臧砚超, 潘进社. 高龄髋部骨折围手术期合并谵妄研究进展[J]. 中国骨与关节损伤杂志, 2013(4): 397-398.
[26] Qiu, Y.W., Sessler, D.I., Chen, L., et al. (2021) Preoper-ative Vitamin D Deficiency Is Associated with Postoperative Delirium in Critically Ill Patients. Journal of Intensive Care Medicine, 37, 655-662. [Google Scholar] [CrossRef] [PubMed]
[27] Velayati, A., Vahdat Shariatpanahi, M., Dehghan, S., Zayeri, F. and Vahdat Shariatpanahi, Z. (2020) Vitamin D and Postoperative Delirium after Coronary Artery Bypass Grafting: A Prospective Cohort Study. Journal of Cardiothoracic and Vascular Anesthesia, 34, 1774-1779. [Google Scholar] [CrossRef] [PubMed]
[28] Habibi Ghahfarrokhi, S., Mohammadian-Hafshejani, A., Sherwin, C.M.T. and Heidari-Soureshjani, S. (2022) Relationship between Serum Vitamin D and Hip Fracture in the Elderly: A Systematic Review and Meta-Analysis. Journal of Bone and Mineral Metabolism, 40, 541-553. [Google Scholar] [CrossRef] [PubMed]
[29] Gao, Q., Sun, T.P. and Wu, G.Y. (2022) Research Progress on Pathophysiological Mechanism of Postoperative Delirium in Elderly Patients. Medical Research and Education, 39, 8-13.
[30] Wen, X.P., Hu, S., Dong, H., et al. (2020) Research Progress on Postoperative Delirium of Hip Fracture in the Elderly. Chinese Journal of Geriatrics, 39, 1219-1222.
[31] Mitchell, R., Harvey, L., Brodaty, H., Draper, B. and Close, J. (2017) One-Year Mortality after Hip Fracture in Older Individuals: The Effects of Delirium and Dementia. Ar-chives of Gerontology and Geriatrics, 72, 135-141. [Google Scholar] [CrossRef] [PubMed]
[32] Wang, X., et al. (2022) Risk Factors of Delirium after Gastroin-testinal Surgery: A Meta-Analysis. Journal of Clinical Nursing, 32, 3266-3276.
[33] Mangnall, L.T., Gallagher, R. and Stein-Parbury, J. (2011) Postoperative Delirium after Colorectal Surgery in Older Patients. American Journal of Critical Care, 20, 45-55. [Google Scholar] [CrossRef] [PubMed]
[34] Gold, C., Ray, E., Christianson, D., Park, B., Kournou-tas, I.A., et al. (2022) Risk Factors for Delirium in Elderly Patients after Lumbar Spinal Fusion. Clinical Neurology and Neurosurgery, 219, Article ID: 107318. [Google Scholar] [CrossRef] [PubMed]
[35] Denny, D.L. and Such, T.L. (2018) Exploration of Relation-ships between Postoperative Pain and Subsyndromal Delirium in Older Adults. Nursing Research, 67, 421-429. [Google Scholar] [CrossRef
[36] Reddy, S.V., Irkal, J.N. and Srinivasamurthy, A. (2017) Postoperative Delirium in Elderly Citizens and Current Practice. Journal of Anaesthesiology Clinical Pharmacology, 33, 291-299. [Google Scholar] [CrossRef
[37] Bednorz, A. and Religa, D. (2023) Utility of the Comprehensive Trail Making Test in the Assessment of Mild Cognitive Impairment in Older Patients. Geriatrics, 8, Ar-ticle 108. [Google Scholar] [CrossRef] [PubMed]
[38] Lynch, E.P., Lazor, M.A., Gellis, J.E., et al. (1998) The Impact of Postoperative Pain on the Development of Postoperative Delirium. Anesthesia and Analgsia, 86, 781-785. [Google Scholar] [CrossRef] [PubMed]
[39] Vaurio, L.E., Sands, L.P., Wang, Y., et al. (2006) Post-operative Delirium: The Importance of Pain and Pain Management. Anesthesia and Analgsia, 102, 1267-1273 [Google Scholar] [CrossRef] [PubMed]
[40] Falk, A., et al. (2022) Depression Is Associated with Delirium after Cardiac Surgery—A Population-Based Cohort Study. Interactive Cardiovascular and Thoracic Surgery, 35, ivac151. [Google Scholar] [CrossRef] [PubMed]
[41] Luger, M.F., et al. (2014) Predictors of Postoperative Cog-nitive Decline in Very Old Patients with Hip Fracture: A Retrospective Analysis. Geriatric Orthopaedical Surgery & Rehabilitation, 5, 165-172. [Google Scholar] [CrossRef] [PubMed]
[42] 朱爱朝, 魏建军, 周俊, 等. 四肢创伤骨折病人术后低蛋白血症的危险因素分析及风险预测模型的构建[J/OL].安徽医药, 2024(2): 376-380. http://kns.cnki.net/kcms/detail/34.1229.r.20240122.1001.072.html, 2024-01-24.
[43] Liu, B., et al. (2022) Recent Ad-vances and Perspectives of Postoperative Neurological Disorders in the Elderly Surgical Patients. CNS Neuroscience & Therapeutics, 28, 470-483. [Google Scholar] [CrossRef] [PubMed]