老年髋部骨折手术病人发生术中低血压与术后谵妄的关系

吴高; 刘夏曦; 胡夏彬; 张婧妤; 沈俊

老年髋部骨折手术病人发生术中低血压与术后谵妄的关系

The relationship between intraoperative hypotension and postoperative delirium in elderly patients undergoing hip fracture surgery

摘要

摘要:
目的： 探讨老年髋部骨折手术病人发生术中低血压（IOH）与术后谵妄（POD）的关系。
方法： 采用回顾性队列研究设计，连续纳入2021年6月至2025年12月接受髋部骨折手术的老年病人。收集一般资料、手术与麻醉信息，IOH定义为术中平均动脉压（MAP）＜60 mmHg或MAP下降超过基线值的20%，并测算低血压的累积持续时长以及曲线下面积（AUC值）。POD采用中文版意识模糊评估量表于术后7日内评估。通过单因素及多因素logistic回归分析IOH与POD的关联，并进一步分析IOH持续时间及严重程度对POD的影响，根据低血压曲线下面积（AUC）及低血压持续时间进行分层分析以及亚组分析。
结果： 术后谵妄总体发生率为28.5%，IOH发生率为51.3%。低血压组POD发生率38.9%高于非低血压组17.5%（P ＜ 0.05），低血压组抑郁型谵妄与混合型谵妄的发生率均高于非低血压组（P ＜ 0.05）。IOH持续时间≥5 min组POD发生率显著高于IOH持续时间＜5 min组（P ＜ 0.05）。多因素logistic回归分析在调整混杂因素后，结果显示，IOH持续时间≥5 min是老年髋部骨折手术病人发生POD的独立危险因素（OR = 3.428，95%CI：1.863～6.304，P ＜ 0.01）。亚组分析显示，各亚组间 OR 值差异无统计学意义（P 交互均＞0.05），但合并脑梗死、术前衰弱评分≥4 分、年龄≥80岁及全身麻醉亚组中，IOH与POD 的关联强度更高（P ＜ 0.05）。
结论： IOH与老年髋部骨折手术病人POD的发生风险显著增加独立相关，持续时间越长风险越高。积极预防并缩短IOH持续时间，对降低这一高危人群的POD发生具有重要临床意义。

Abstract:
Objective To explore the relationship between intraoperative hypotension (IOH) and postoperative delirium (POD) in elderly patients undergoing hip fracture surgery.
Methods A retrospective cohort study design was adopted, and the elderly patients treated with hip fracture surgery from June 2021 to December 2025 were consecutively included. The general data, surgical and anesthesia information were collected. IOH was defined as intraoperative mean arterial pressure (MAP) ＜ 60 mmHg or a decrease in MAP exceeding 20% of the baseline value. The cumulative duration of hypotension and area under the curve (AUC value) were calculated. POD was evaluated within 7 days after the operation using the Chinese version of the Confusion Assessment Scale. The association between IOH and POD was analyzed through univariate and multivariate logistic regression analysis, and the effects of IOH duration and severity on POD were further analyzed. Stratified analysis and subgroup analysis were conducted based on the area under the hypotension curve (AUC) and hypotension duration.
Results The overall incidence of postoperative delirium was 28.5%, and the incidence of IOH was 51.3%. The incidence of POD in the hypotension group was 38.9%, which was higher than 17.5% in the non-hypotension group (P ＜ 0.05). The incidences of depressive delirium and mixed delirium in the hypotension group were higher than those in the non-hypotension group (P ＜ 0.05). The incidence of POD in the group with IOH duration ≥5 min was significantly higher than that in the group with IOH duration ＜5 min (P ＜ 0.05). The results of multivariate logistic regression analysis, after adjusting for confounding factors, showed that IOH duration ≥5 min was an independent risk factor of POD in elderly patients undergoing hip fracture surgery (OR = 3.428, 95%CI: 1.863–6.304, P ＜ 0.01). Subgroup analysis showed that there was no statistically significant difference in OR values among the subgroups (all P interactions ＞ 0.05), but in the subgroups with cerebral infarction, preoperative frailty score ≥4 points, age ≥80 years, and general anesthesia, the association strength between IOH and POD was higher (P ＜ 0.05).
Conclusions IOH is independently associated with a significantly increasing risk of POD occurrence in elderly patients undergoing hip fracture surgery, and the longer the duration, the higher the risk. Actively preventing and shortening the duration of IOH is of great clinical significance for reducing the occurrence of POD in this high-risk population.

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