老年髋关节置换术后谵妄与非谵妄患者康复疗效及远期预后分析OA

Objective To investigate rehabilitation outcome and long-term prognosis in elderly patients with delirium and non-delirium after hip arthroplasty.Methods A retrospective observation study was conducted to analyze the data of elderly post-hip re-placement patients admitted to the Rehabilitation Department of the Second Hospital of Beijing from January 2015 to December 2019.54 patients were divided into delirium group and non-delirium group according to whether delirium occurred after surger-y.General data,ADL scores during hospitalization and functional outcomes at 1 year after operation(walking,bedridden state or death)of the two groups were compared.Results Among the 54 elderly patients after hip replacement,33 were females and 21 were males,aged 65～96 years,with an average age of(79.72±7.13)years.There were 11 patients in the delirium group,including 4 females and 7 males,with an average age of(82.09±8.59)years.There were 43 patients in the non-delirium group,including 29 females and 14 males,with an average age of(79.12±6.70)years,and there was no significant difference in age between the two groups(t=1.239,P=0.221＞0.05).The ADL scores of the delirium group were 30(20,40)at admission and 30(20,40)at 21 days in hospital,and the ADL difference was 0(0,5).In the non-delirium group,the ADL score was 40(35,50)at admission,65(55,75)at 21 days in hospital,and the ADL difference was 20(15,30).There was no significant difference in ADL scores before and after rehabilitation in the delirium group(Z=-1.414,P=0.157＞0.05).There was significant difference in ADL scores be-fore and after rehabilitation in the non-delirium group(Z=-5.728,P=0.000＜0.05).There was a statistically significant differ-ence in ADL scores between the two groups at admission(Z=-2.822,P=0.005＜0.05),and there was a statistically significant difference in ADL difference between the two groups(Z=-4.999,P=0.000＜0.05).In delirium group,2 patients died and 9 pa-tients survived at 1 year after operation.None of them could walk independently,4 patients(36.4％)needed to walk with auxiliary devices,and 5 patients(45.4％)were bedridden.There was no death in the non-delirium group at 1 year after operation,36 cases(83.7％)could walk independently,6 cases(14.0％)needed to walk with auxiliary devices,and 1 case(2.3％)was bedridden,the difference between the two groups was statistically significant(P=0.000＜0.05).Conclusion Among elderly patients after hip replacement,the rehabilitation effect of non-delirium patients within 1 month after surgery was significantly better than that of de-lirium patients,the survival,staying in bed and walking ability of the non-delirium group was better than that of the delirium group at 1 year after surgery.The short-term and long-term prognosis of the non-delirium group was better than that of the delirium group.Reducing the incidence of postoperative delirium is the key to improving the overall prognosis of patients.