术前糖化血红蛋白水平与老年髋关节置换术后谵妄的关系研究

摘要 目的：探讨术前糖化血红蛋白（HbAlc）水平与老年髋关节置换术后谵妄的关系，并分析术后发生谵妄的影响因素。方法：选择我院于2019年4月~2020年6月期间收治的行髋关节置换术的220例老年患者作为研究对象。收集患者临床资料，记录其术后发生谵妄情况。采用单因素及多因素Logistic回归分析术后发生谵妄的影响因素。采用Pearson相关分析评估患者术前HbAlc水平与术后意识障碍评估量表（CAM）评分的相关性。结果：220例患者根据剔除标准剔除20例，最终200例老年髋关节置换术后患者出现谵妄42例，发生率为21.00%（42/200）。将发生谵妄的患者纳为谵妄组（n=42），未发生谵妄的患者纳为非谵妄组（n=158）。谵妄组的术前HbAlc水平、术后CAM评分均高于非谵妄组（P<0.05）。Pearson相关分析显示，患者术前HbAlc水平与术后CAM评分呈正相关（P<0.05）。单因素分析结果显示，老年髋关节置换术后发生谵妄与年龄、术前合并呼吸系统性疾病、手术时间、发生低氧血症、术后疼痛评分、存在电解质紊乱有关（P<0.05），多因素Logistic回归分析结果显示，年龄>80岁、发生低氧血症、术后疼痛评分＞3分、术前HbAlc水平＞8%均是老年髋关节置换术后发生谵妄的危险因素（P<0.05）。结论：高龄、术前HbAlc水平较高的患者是髋关节置换术后发生谵妄的高危人群，且围术期应尽量给予减少疼痛、预防术后低氧血症的措施，以降低术后谵妄的发生风险。

Relationship Study between Preoperative Glycosylated Hemoglobin Level and Postoperative Delirium in Elderly Patients Undergoing Hip Arthroplasty

ABSTRACT Objective: To investigate the relationship between preoperative glycosylated hemoglobin (HbAlc) level and postoperative delirium in elderly patients undergoing hip arthroplasty, and to analyze the influencing factors of delirium. Methods: 220 elderly patients undergoing hip arthroplasty in our hospital from April 2019 to June 2020 were selected as the research objects. The general information of the patients was collected, and the incidence of postoperative delirium was recorded. Univariate and multivariate Logistic regression were used to analyze the influencing factors of postoperative delirium. Pearson correlation analysis was used to evaluate the correlation between preoperative HbAlc level and postoperative disturbance of consciousness (CAM) scores. Results: 220 patients were excluded from 20 cases according to the exclusion criteria, in the end 200 cases of delirium after hip arthroplasty in the elderly were 42 cases, the incidence was 21.00%(42/200). Patients with delirium were included in the delirium group (n=42), and patients without delirium were included in the non-delirium group(n=158). The preoperative HbAlc level and postoperative CAM scores of delirium group were higher than those of non-delirium group(P<0.05). Pearson correlation analysis showed that preoperative HbAlc level was positively correlated with postoperative CAM scores(P<0.05). Univariate analysis showed that the incidence of delirium after hip arthroplasty was related to age, preoperative merge systemic respiratory disease, operation time, hypoxemia occurs, postoperative pain score and electrolyte disorders(P<0.05). Multivariate Logistic regression analysis showed that age over 80 years old, hypoxemia occurs, postoperative pain score over 3 scores, preoperative HbAlc level over 8% were the risk factors of delirium of elderly patients undergoing hip arthroplasty (P<0.05). Conclusion: Elderly age and high HbAlc level are the high-risk groups of delirium. Perioperative measures should be taken to reduce pain and prevent postoperative hypoxemia, so as to reduce the incidence of delirium.