摘 要
随着人口老龄化加剧，老年骨折患者术后谵妄发生率逐年上升，严重影响患者康复质量及预后。本研究旨在探讨老年骨折患者术后谵妄的风险因素并提出预防策略。通过系统回顾国内外相关文献，并选取某三甲医院2018 - 2022年期间356例老年骨折手术患者作为研究对象，采用病例对照研究方法，收集患者一般资料、术前身体状况、手术相关信息、术后护理情况等数据。经统计分析发现，年龄≥75岁、合并多种基础疾病（如心血管疾病、糖尿病等）、术前认知功能障碍、麻醉方式为全身麻醉、手术时间超过2小时、术后疼痛控制不佳、电解质紊乱等因素与术后谵妄发生显著相关。创新性地构建了基于多因素Logistic回归模型的风险预测体系，可提前识别高危人群。同时提出综合性预防措施，包括优化围手术期管理流程，加强术前评估与准备，选择适宜麻醉方案，强化术后镇痛和营养支持，改善病房环境等。研究表明，针对风险因素采取积极干预措施能够有效降低老年骨折患者术后谵妄的发生率，提高患者术后生活质量，为临床实践提供重要参考依据。
关键词：术后谵妄；老年骨折患者；风险因素；预防策略；Logistic回归模型
Abstract
As the aging population increases, the incidence of postoperative delirium in elderly patients with fractures has been rising annually, significantly affecting rehabilitation quality and prognosis. This study aims to investigate risk factors for postoperative delirium in elderly fracture patients and propose preventive strategies. By systematically reviewing relevant domestic and international literature, and selecting 356 elderly patients who underwent fracture surgery at a tertiary hospital from 2018 to 2022 as subjects, a case-control study method was employed to collect data on general patient information, preoperative physical condition, surgical details, and postoperative care. Statistical analysis revealed that factors such as age ≥75 years, multiple comorbidities (e.g., cardiovascular diseases, diabetes), preoperative cognitive impairment, general anesthesia, surgery duration exceeding two hours, inadequate postoperative pain control, and electrolyte disturbances were significantly associated with the occurrence of postoperative delirium. Innovatively, a risk prediction system based on a multivariate logistic regression model was constructed to identify high-risk populations in advance. Comprehensive preventive measures were also proposed, including optimizing perioperative management processes, enhancing preoperative evaluation and preparation, selecting appropriate anesthesia protocols, strengthening postoperative analgesia and nutritional support, and improving ward environments. The study demonstrates that implementing proactive interventions targeting these risk factors can effectively reduce the incidence of postoperative delirium in elderly fracture patients, thereby improving postoperative quality of life and providing crucial reference for clinical practice.
Keywords：Postoperative Delirium；Elderly Fracture Patients；Risk Factors；Prevention Strategies；Logistic Regression Model
目 录
摘 要 I
Abstract II
引 言 1
第一章 老年骨折患者术后谵妄概述 2
1.1 术后谵妄的定义与特征 2
1.2 发病率及临床表现 2
1.3 研究意义与目的 3
第二章 术后谵妄的风险因素分析 5
2.1 年龄与基础疾病影响 5
2.2 手术相关风险因素 5
2.3 围手术期管理因素 6
第三章 预防术后谵妄的策略 7
3.1 术前评估与准备 7
3.2 术中管理措施 7
3.3 术后护理干预 8
第四章 综合防控体系构建 10
4.1 多学科协作模式 10
4.2 患者及家属教育 10
4.3 长效机制建立 11
结 论 12
参考文献 13
致 谢 14
