成年患者髋部骨折术后谵妄的危险因素：系统回顾与meta分析

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成年患者髋部骨折术后谵妄的危险因素：系统回顾与meta分析

翻译：何幼芹  编辑：冯玉蓉  审校：曹莹

背景：术后谵妄(POD)是髋部骨折患者术后最常见的并发症，其发生率与髋部骨折术后患者的死亡率和致残率有关。因此，本研究旨在明确与成人髋部骨折手术后POD相关的个体以及麻醉和手术危险因素。

方法：检索Cochrane图书馆、PubMed和Embase数据库在2020年2月之前发表的相关文章。涉及接受髋部骨折手术的成年患者的研究如果包含参与者的个体特征或麻醉和手术特征，则被纳入研究。用Mantel- Haenszel或方差倒数法估计变量的合并相对危险度或加权平均差值。

结果：共纳入44项研究，包括104572例行髋部骨折手术的成年患者（POD 17703例，非POD 86869例），POD的发生率为16.93%。初步鉴定出14个危险因素（分为个体因素和麻醉、手术因素两大类），包括年龄(WMD:2.33；95% CI:1.64~3.03)、性别(RR:0.89; 95% CI: 0.85~ 0.93)、ASA分级(RR:0.56; 95% CI:0.51~0.59)、BMI(WMD：-0.62；95%CI：-0.81~ -0.44)、功能依赖性(RR:1.52；95% CI:1.24~1.87)、视力损害(RR:1.62；95% CI:1.16~2.27)、吸烟(RR:0.86；95% CI: 0.79~ 0.94)、术前谵妄(RR：2.71；95% CI：2.50~2.72)、痴呆(RR:2.60；95% CI：2.50~2.72)、高血压(RR:1.10；95% CI:1.04~1.15)、慢性阻塞性肺疾病(RR:1.08；95% CI:1.01~1.16)、区域麻醉(RR:1.20；95% CI：1.01~1.43)、输血(RR:1.41; 95% CI:1.22~1.63) 和择期手术(RR: 0.91; 95% CI:0.84~0.99)。

结论：具有上述危险因素的髋部骨折成年患者可能是POD发生的高危患者。临床医生应高度警惕这些患者发生POD。

原始文献来源：Wu J,  Yin Y,  Jin M, et al. The risk factors for postoperative delirium in adult patients after hip fracture surgery: a systematic review and meta-analysis[J] .Int J Geriatr Psychiatry, 2020, undefined: undefined.

The risk factors for postoperative delirium in adult patients after hip fracture surgery: a systematic review and meta-analysis

Abstract

Objectives: Postoperative delirium (POD) is the most common complication in patients after hip fracture surgery, and the incidence of POD is associated with mortality and disability in patients following hip fracture surgery. Therefore, this study aimed to identify the individual as well as anesthetic and operative risk factors associated with the POD in adult patients after hip fracture surgery.

Methods: We searched relevant articles published to February 2020 in Cochrane Library, PubMed and Embase. Studies involving adult patients who underwent hip fracture surgery were regarded as relevant if the studies contained the individual or anesthetic and surgical characteristic of participants. The pooled relative risk ratios or weight mean difference of the variables were estimated by the Mantel–Haenszel or Inverse-Variance methods.

Results: A total of 44 studies were included, which altogether included 104572 participants with hip fracture surgery (17703 patients with POD and 86869 patients without POD) and the incidence of POD was 16.93%. A total of 14 risk factors, classified into two categories which were individual as well as anesthetic and operative factors, were identified originally, which included age(WMD:2.33； 95%CI: 1.64~3.03), sex(RR:0.89;95%CI:0.85~0.93), American society of Anesthesiologists classification(RR:0.56;95%CI:0.51~0.59), Body Mass Index(WMD:-0.62; 95%CI:-0.81~ -0.44), function dependency (RR:1.52; 95%CI:1.24~1.87), visual impairment(RR:1.62；95%CI:1.16~2.27), smoking(RR:0.86; 95%CI:0.79~0.94), preoperative Delirium (RR:2.71;95%CI:2.50~2.72), dementia(RR:2.60; 95%CI:2.50~2.72), hypertension(RR:1.10;95%CI:1.04~1.15), chronic obstructive pulmonary disease(RR:1.08;95%CI:1.01~1.16), regional anesthesia (RR:1.20;95%CI:1.01~1.43), transfusion(RR:1.41;95%CI:1.22~1.63) and elective surgery(RR:0.91;95%CI:0.84~0.99).

Conclusions: Patients possessed above risk factors might be high-risk patients. Clinician should maintain keen vigilance at those patients.

          贵州医科大学高鸿教授课题组

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