고령의 환자에서 고관절 치환술 후 발생한 섬망
Postoperative Delirium after Hip Arthroplasty in the Elderly
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서론: 본 연구는 65세 이상의 환자에서 고관절 치환술 후 섬망이 고관절 치환술의 경과에 끼치는영향과 섬망의 위험인자에 대하여 알아보고자 하였다. 대상 및 방법: 2004년 3월부터 2008년 3월까지 본원에서 고관절 치환술을 시행한 65세 이상의환자 중 총 193명의 환자를 대상으로 하였다. 이 중 섬망이 발생하지 않은 131명과 섬망이 발생한 환자 62명을 두 군으로 나누어 수술의 임상 결과를 확인하였다. 또한 섬망의 발생유무와 유의한 상관관계를 가진 인자들을 조사하였다. 결과: 수술 당시 재원기간은 섬망군에서 유의하게 높은 수치를 보였다. 술 전의 축적 보행 점수는섬망군에서 유의하게 낮은 수치를 보였다. 탈구에 있어서는 비섬망군 2명, 섬망군은 4명에서 탈구를 경험하였으며 유의한 차이가 있었다. 원인질환 중 고관절부 골절에서 섬망의 발생이 유의하게 높았으며, 기저질환 중 정신질환, 알코올 남용, 간경화증, 뇌혈관질환이 섬망군에서 유의하게높은 빈도를 보였다. 중환자실 재원기간도 섬망군에서 길었으며, 혈액 검사상 혈중 나트륨 및 알부민 수치가 섬망군에서 유의하게 낮은 수치를 보였다. 결론: 고관절 치환술 후 섬망은 수술의 결과를 악화시키므로 수술 전 섬망에 관련된 위험인자에대한 평가 및 처치를 시행해야 한다.
Abstract
Purpose: Our study was done to evaluate the influence of postoperative delirium on the prognosis of hip arthroplasty,and risk factors for postoperative delirium in individuals older than 65. Materials and Methods: Among patients who received hip arthroplasty in our hospital (WCH) between March 2004and March 2008, we chose 193 patients for our study after excluding patients who had preoperative delirium and who had a history of dementia and cognitive dysfunction. We divided our cohort of 193 patients into two groups, 131patients with postoperative delirium and 62 patients without delirium. We checked for clinical results for hip arthroplasty. We checked for multiple factors related to delirium. Results: The mean hospital stay was 42.4±14.0 in the delirium group and 20.4±4.3 in the control group; the difference was significant. The mean preoperative cumulative ambulation score was 1.9±1.2 in the delirium group and 3.1±1.7 in the control group; the difference was significant. In 2 individuals of the control group and 4 of the delirium group, dislocation developed;and there was significant difference. There was a high prevalence of delirium among patients with hip fractures, and of histories of psychiatric diseases, alcohol abuse, liver cirrhosis and cerebral vascular disease. The delirium group had a significantly longer stay in the intensive care unit. On admission, the delirium group had significantly lower sodium and albumin compared to controls. Conclusion: Because postoperative delirium after hip arthroplasty makes the prognosis worse, preoperative evaluation and management of risk factors is necessary.
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