文章摘要
高原患者髋关节置换术后谵妄的危险因素分析
Risk factors of postoperative delirium in patients from high altitude undergoing total hip arthroplasty
  
DOI：10.12089/jca.2023.02.011
中文关键词: 高原  危险因素  术后谵妄  髋关节置换术  全身麻醉
英文关键词: High altitude  Risk factors  Postoperative delirium  Hip arthroplasty  General anesthesia
基金项目:西藏自治区自然科学基金项目（XZ202001ZR0045G，XZ202101ZR0049G）
作者单位E-mail
叶晓莉 610041,成都市,西藏自治区人民政府驻成都办事处医院,四川大学华西医院西藏成办分院麻醉科  
尚凯茜 610041,成都市,西藏自治区人民政府驻成都办事处医院,四川大学华西医院西藏成办分院麻醉科 shang_2310@163.com 
孙琪荣 四川大学华西医院麻醉手术中心  
李卓柠 610041,成都市,西藏自治区人民政府驻成都办事处医院,四川大学华西医院西藏成办分院麻醉科  
夏宗敬 610041,成都市,西藏自治区人民政府驻成都办事处医院,四川大学华西医院西藏成办分院麻醉科  
王辉 610041,成都市,西藏自治区人民政府驻成都办事处医院,四川大学华西医院西藏成办分院麻醉科  
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中文摘要:
      
目的 探讨全麻下行髋关节置换术的高原患者发生术后谵妄（POD）的危险因素。
方法 选择择期行全麻髋关节置换术的高原患者1 010例，男373例，女637例，年龄24～76岁，BMI 19.0～34.7 kg/m2，ASA Ⅰ—Ⅲ级。根据术后7 d内是否发生谵妄分为两组：POD组和非POD组，采用多因素Logistic回归分析确定行髋关节置换术的高原患者发生POD的相关危险因素。
结果 术后7 d内有120例（11.9%）患者发生POD。多因素Logistic回归分析显示，年龄（每增加10岁，OR=2.106，95%CI 1.616～2.745，P<0.001）、脑梗死病史（OR=9.712，95%CI 3.620～26.055，P<0.001）、术后中重度疼痛（OR=6.826，95%CI 2.991～15.578，P<0.001）以及常居海拔高度3 500～4 500 m（OR=2.844，95%CI 1.448～5.587，P=0.002）和高原红细胞增多症（OR=5.374，95%CI 3.900～7.404，P<0.001）是发生POD的危险因素。
结论 年龄、脑梗死病史、术后中重度疼痛以及常居海拔高度3 500～4 500 m和高原红细胞增多症是高原患者全麻下髋关节置换发生POD的危险因素。
英文摘要:
      
Objective To evaluate the risk factors of postoperative delirium (POD) in patients from high altitude undergoing total hip arthroplasty.
Methods A total of 1 010 patients undergoing elective general anesthesia for total hip arthroplasty, 373 males and 637 females, aged 24-76 years, BMI 19.0-34.7 kg /m2, ASA physical statusⅠ—Ⅲ, were retrospectively analyzed. The patients were divided into two groups according to whether POD occurred during 7 days after surgery: POD group and non-POD group. Multivariate logistic regression was used to analyze the risk factors of POD in patients from high altitude undergoing total hip arthroplasty.
Results The total POD occurred in 120 patients (11.9%). Multivariate logistic regression analysis showed that every additional 10 years of age (OR=2.106, 95% CI 1.616-2.745,P < 0.001), history of cerebral infarction (OR = 9.712, 95% CI 3.620-26.055, P < 0.001), moderate to severe postoperative pain (OR = 6.826, 95% CI 2.991-15.578, P < 0.001) as well as resident altitude 3 500-4 500 m (OR = 2.844, 95% CI 1.448-5.587, P = 0.002) and high altitude polycythemia(OR = 5.374, 95% CI 3.900-7.404, P < 0.001) were the risk factors of POD.
Conclusion Age, history of cerebral infarction, moderate to severe postoperative pain, as well as resident altitude 3 500-4 500 m and high altitude polycythemia are the risk factors of POD in patients from high altitude undergoing total hip arthroplasty.
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