目的 探讨高龄髋部骨折患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的特点及防治康复措施。方法 回顾性分析2011-01至2014-01收治的70岁以上髋部骨折手术患者120例的临床资料,其中术后出现POCD患者40例, 探讨其临床特点、发生原因及防治措施。结果 经对症处理及综合治疗后,25 例术后 1 周内认知功能障碍好转,13 例术后 2 周内好转,2 例术后随访6个月仍有认知功能障碍。高龄髋部骨折POCD发病与术前认知障碍、围术期贫血、术中出血量及手术时间相关。结论 认识到POCD不是单一因素造成的,也不是多种因素的简单相加,而是病因与疾病之间,甚至病因与病因之间的相互联系、相互作用的结果。
Abstract
Objective To observe postoperative cognitive dysfunction (POCD) in elderly patients with hip fracture, to understand its pathogenesis, clinical manifestations, give prevention and treatment measures to promote early rehabilitation of the patients.Method Clinical data of 120 hip fracture patients were retrospectively analyzed from January 2011 to January 2014 in this hospital. All patients’ age were older than 70 years. There were 40 patients diagnosed as having POCD after surgery, to explore the clinical features, causes and prevention measures.Results After symptomatic treatment and comprehensive treatment, 25 of 40 POCD patients’ cognitive dysfunction improved within 1 week postoperatively, 13 cases improved within 2 weeks after surgery. But 2 cases still had cognitive dysfunction 6 months postoperatively.Conclusions The incidence of POCD in elderly patients with hip fracture is associated with preoperative cognitive impairment, perioperative anemia, blood loss in operation and operation time. But we should be aware that POCD is not caused by a single factor, it is not a simple sum of a variety of factors, but the multiple factors interaction.
关键词
髋部骨折 /
认知功能障碍 /
临床观察 /
高龄
Key words
Hip fracture /
cognitive dysfunction /
clinical observation /
elderly patients
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参考文献
[1] Rudolph J L,Marcantonio E R. Review articles: postoperative delirium: acute change with long-term implications[J]. Anesth Analg,2011,112: 1202-1211.
[2] 郑筱萸. 中药新药临床研究指导原则[M]. 北京: 中国医药科技出版社,2002:68-73.
[3] Van Gool W A,Van de Beek D,Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide[J]. Lancet,2010,375: 773-775.
[4] Lee H B,Mears S C,Rosenberg P B,et al. Predisposing factors for post-operative delirium after hip fracture repair in individuals with and without dementia[J]. J Am Geriatr Soc,2011,59: 2306-2313.
[5] Brown C A,Boling J,Manson M,et al. Relation between prefracture characteristics and perioperative complications in the elderly adult patient with hip fracture[J]. South Med J,2012,105: 306-310.
[6] Nie H,Zhao B,Zhang Y Q,et al. Pain and cognitive dysfunction are the risk factors of delirium in elderly hip fracture Chinese patients [J]. Arch Gerontol Geriatr,2012,54: 172 -174.
[7] Vochteloo A J,Borger van der Burg B L,Mertens B,et al. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients[J].BMC Musculoskelet Disord,2011,12: 262.
[8] Radtke F M,Franck M,Lendner J,et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction[J]. Br J Anaesth,2013,110: 98-105.
[9] Zapatero A,Barba R,Canora J,et al. Hip fracture in hospitalized medical patients[J]. BMC Musculoskelet Disord,2013,14:15.
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