Clinical Study Of Postoperative Delirium Inelderly Patients Undergoing Knee Or Hip Replacement

【Objective】 To observe the incidence of postoperative delirium(POD)and the recovery of cognitive function in elderly patients undergoing knee or hip replacement undergoing combined spinal-epidural anesthesia(CSEA).Through the detection of inflammatory factors,the related risk factors and related pathogenesis of POD after knee or hip replacement in elderly patients were analyzed.【Methods】 To collect 100 elderly patients undergoing hip or knee arthroplasty under CSEA from February 2016 to December 2017 in our hospital.The patients were all ≥ 65 years of age.The patient’s gender,age,number of consultations,days of hospitalization,complications,intraoperative blood pressure,heart rate,oxygen saturation,medication,bleeding,urine output,medication,etc.were recorded;the confusion assessment method(CAM)was used,visual analogue scale(VAS)and mini-mental state examination(MMSE)to evaluate preoperative(T1),immediate end of surgery(T2),postoperative day 2(T3),postoperative day 5(T4)Whether there was postoperative delirium(POD)at the time point;and collect peripheral venous blood from the above four time points for ELISA test to detect the serum IL-1β,IL-6,TNF-α and S100β levels,and record the data.The data collected was analyzed using SPSS 24.0 statistical software.Measured data were expressed as `x ± s.Within the group,comparison analysis was used to design variance analysis.Group comparison was performed using t test.Count data were compared using χ2 test.P ≤ 0.05 was considered statistically significant.【Results】Chi-square test was used to distinguish the differences in gender,age,BMI,hypertension,diabetes,arrhythmia,and surgical methods between the two groups.There was a statistically significant difference in the age distribution between the two groups.The ages of patients in the delirium group were significantly older than those in the non-delirium group(c 2=11.679,P=0.003);The proportion of patients with diabetes mellitus and arrhythmia was significantly higher in the delirium group than in the innocent group of patients without delirium(P>0.05).The difference was statistically significant(c2 were 16.280 and 11.583,respectively,P <0.001 and 0.001).Significance(c2 = 7.791,P = 0.020);Rank sum test was used to compare the length of hospitalization,operative time,blood loss and urine volume between the two groups.The results showed that there was no significant difference between the two groups.Independent sample t test was used to compare the patient’s heart rate,systolic blood pressure.Differences in diastolic blood pressure and mean arterial pressure,the results showed that,with the exception of systolic blood pressure(t=-3.537,P=0.001),the other factors were not statistically significant between the two groups.Whether or not a delirium occurred as a dependent variable and multivariate logistic regression analysis of age,diabetes,arrhythmia,systolic blood pressure,and surgery were used as independent variables to analyze the independent influencing factors affecting delirium.The results indicated that age,arrhythmia,and diabetes affect the independent risk factors of delirium,the older the higher risk of delirium is.Compared with the age group of 65-75-year-old,the risk of delirium occurrence in the 75-85-year-old group and the ≥ 85-year-old group is 4.046(0.668-24.507)and25.973,respectively.(3.128-215.656)times.The risk of delirium in patients with arrhythmia was 5.171(1.408-23.664)times that in the non-combined group,P=0.015;diabetic patients had higher risk of delirium compared with non-diabetic patients(OR=8.786(1.937-39.840),P=0.008).As a protective factor for delirium,the systolic blood pressure increased and the risk of occurrence of delirium decreased.OR=0.946(0.908-0.985),P=0.007.By Mann-Whitnye U test,there was no statistically significant difference in S100β between different systolic blood pressure segmented groups.The difference in IL-1 β between the different groups was statistically significant at T1,T3,and T4.The systolic blood pressure ≥140 mm Hg group was significantly higher than <140 mm Hg.At T1 and T4,there was a statistically significant difference between groups in IL-6 and TNF-α,and the systolic blood pressure ≥140 mm Hg group was significantly higher than the <140 mm Hg group.【Conclusions】1.Age is an independent risk factor for postoperative delirium;2.Preoperative diabetes mellitus,arrhythmia and postoperative delirium are related,which is consistent with our clinical observation.Diabetic-induced vascular disease,and arrhythmia leading to circulatory instability may be the cause of delirium;3.Maintaining high systolic blood pressure during surgery is a protective factor for delirium,but because of the small sample size in this group,blood pressure is not analyzed in subgroup,and it is not certain that blood pressure is maintained at that level.The use of intraoperative triple vasoactive drugs has a certain effect on the maintenance of intraoperative blood pressure,but whether it is relevant to postoperative delirium is still to be confirmed in future studies.4.After surgery,the patient’s consciousness returned to or near the preoperative level at 1 week after surgery.In our hospital after the knee or hip joint replacement surgery to encourage early out of bed,strengthen diet,improve mental status,has formed a protocal,these patients have improved the recovery of postoperation.