髋部骨折后谵妄的发病机制及治疗策略综述。

Martin Bitsch, Nicolai Foss, Billy Kristensen, Henrik Kehlet
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引用次数: 109

摘要

背景:老年髋部骨折术后谵妄是常见且严重的并发症,导致并发症的发生风险增加。病理生理机制尚不清楚,但可能是多因素的。本综述的目的是总结目前关于术后谵妄发病机制的知识,以期找到预防和治疗的策略。方法:通过Medline数据库(1966- 2003年3月)进行网络检索,并辅以人工检索。我们纳入了12项专门讨论髋部骨折术后谵妄的致病因素或干预措施的研究。结果:纳入1823例患者,谵妄发生率平均为35%。我们集中研究术前、术中和术后的危险因素。只有高龄和痴呆符合我们确定的“有力证据”标准,证明两者之间存在显著关联。因此,从我们回顾的研究中,我们无法发现术中或术后因素与谵妄有“强有力的证据”。结论:术后谵妄是一种严重的并发症。导致髋部骨折术后谵妄的病理生理机制尚不清楚,没有单一药物或手术方案被证明是预防的。这需要对不同致病机制的不同作用进行更详细的调查,并采用积极的多模式方法来提高恢复和降低发病率,这在各种选择性外科手术中已被证明是成功的。这种多模式介入研究是骨科部门与麻醉师、老年病学家、物理治疗师和护理人员合作的一项主要任务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review.

Background: Postoperative delirium is a frequent and serious complication in elderly patients following operation for hip fracture, leading to an increased risk of complications. The pathophysiological mechanisms are unresolved, but probably multifactorial. The purpose of this review is to summarize current knowledge about the pathogenesis of postoperative delirium with a view to finding strategies for prevention and management.

Method: We conducted an Internet search through the Medline database (1966-March 2003) and supplemented it with a manual search. We included 12 studies which specifically discussed pathogenic factors or interventions against postoperative delirium following operation for hip fracture.

Results: 1,823 patients were included with an average incidence of delirium of 35%. We concentrated on pre-, intra-, and postoperative risk factors. Only advanced age and dementia met our fixed criterion of "strong evidence" for a significant association. Hence, from the studies that we reviewed we were unable to find intraoperative or postoperative factors with "strong evidence" for a significant association with delirium.

Interpretation: Postoperative delirium is a serious complication. The pathophysiology leading to delirium after hip fracture surgery still remains to be clarified and no single drug or surgical regimen has proven to be preventive. This calls for more detailed investigations of the differential role of different pathogenic mechanisms, as well as an aggressive multimodal approach to enhance recovery and reduce morbidity, as has proven to be successful in a variety of elective surgical procedures. Such multimodal interventional studies represent a major task for orthopedic departments in collaboration with anesthesiologists, geriatricians, physiotherapists and nursing staff.

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