Journal of the Korean Fracture Society (대한골절학회지)

The Korean Fracture Society (대한골절학회)
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Risk Factors of Postoperative Delirium in Elderly Patients with Hip Fractures

고관절부 골절 환자에서 수술 후 섬망을 일으키는 위험인자

Kim, Ki-Hwan;Kho, Duk-Hwan;Shin, Ju-Yong;Choi, Jin-Yong;Kim, Eung-Sik;Kim, Dong-Heon
김기환;고덕환;신주용;최진영;김응식;김동현

  • Published : 2008.07.01
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Abstract

Purpose: To find out the relationship between various risk factors and post-operative delirium in elderly patients with hip fractures. Materials and Methods: Out of 135 patients older than 65 years old who underwent the surgery for hip fracture in our department, between the periods of March 2003 to March 2005, 14 patients (10.4%) developed post-operative delirium and 121 patients (89.6%) did not. We studied risk factors of post-operative delirium in two groups. Results: In chi-square test between delirium group and non-delirium group, the patients were more likely to develop post-operative delirium if they had previous episodes of delirium, abnormal cognitive function, low walking ability before admission, high dependency on ADL (Activities of Daily Living), other medical accompanying diseases, history of dementia, post-operative hypoxia, post-operative electrolyte imbalance, low post-operative hemoglobin and hematocrit, low post-operative albumin and were older than 75 years old (p＜0.05). Sex, type of fracture, anesthesia and the time between admission and operation did not show much difference between the two groups. Conclusion: The risk factors of postoperative delirium in elderly patients with hip fracture have a tendency to be multifactorial. Therefore, we conclude that being prepared by thorough understanding of the risk factors and their relationships will help prevent post-operative delirium and result in good postoperative prognosis.

목적: 고령의 고관절부 환자에서 수술 후 섬망을 일으키는 원인이 되는 인자들을 파악하여 상관관계를 알아보고자 하였다. 대상 및 방법: 2001년 3월부터 2005년 3월까지 본원 정형외과에서 고관절부 골절에 대한 수술적 치료를 시행한 65세 이상의 환자 135명 중 수술 후 섬망을 보인 14명과 (10.4%) 수술 후 섬망을 보이지 않은 121명의 (89.6%) 대조군 간에 섬망을 일으키는 원인으로 알려진 인자에 대해 비교 조사하였다. 결과: 수술 후 섬망군과 비섬망군 간의 카이 자승 검사상 75세 이상의 고령, 이전 섬망의 과거력, 인지기능장애가 있는 경우, 입원이나 수상 전 보행능력이 낮을수록, ADL 의존도가 높을수록, 내과적 동반질환이 많을수록, 치매가 있는 경우, 수술 후 저산소증, 수술 후 전해질 불균형이 있는 경우, 수술 후 헤모글로빈, 헤마토크릿 수치가 낮을수록, 수술 후 알부민 수치가 낮을수록 섬망이 잘 나타났다 (p＜0.05). 성별, 골절 분류, 수술 방법, 마취방법, 입원 후 수술까지의 기간은 수술 후 섬망군과 비섬망군 간의 큰 차이를 보이지 않았다. 결론: 고령의 고관절부 골절 환자에서 수술 후 섬망을 일으키는 원인은 다양하면서 다인자적인 성향이 있었다. 따라서 섬망의 원인이 되는 여러 인자에 대한 철저한 이해와 상관관계를 파악하고 대비하는 것이 수술 후 섬망의 발생 예방 및 고관절부 수술 후 예후에 좋은 영향을 줄 것으로 생각한다.

Keywords

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