Relationship between pain and opioid analgesics on the development of delirium following hip fracture.
Relationship between pain and opioid analgesics on the development of delirium following hip fracture.
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DOI：
10.1093/gerona/58.1.m76
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
R. Morrison;J. Magaziner;M. Gilbert;K. Koval;M. McLaughlin;G. Orosz;E. Strauss;A. Siu
中科院分区：
文献类型：
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作者：
R. Morrison;J. Magaziner;M. Gilbert;K. Koval;M. McLaughlin;G. Orosz;E. Strauss;A. Siu
背景：谵妄和疼痛是髋部骨折后常见的症状。未经治疗的疼痛已被证明会增加接受选择性手术的老年人谵妄的风险。本研究旨在探讨疼痛、镇痛药及其他因素与髋部骨折患者谵妄的关系。方法：我们在纽约四家医院进行了一项前瞻性队列研究，纳入了541例髋部骨折且无谵妄的患者。谵妄是通过病人访谈和病历回顾来确定的。采用多元逻辑回归确定危险因素。结果541例患者中有87例（16%）出现神志不清。在所有受试者中，谵妄的危险因素是认知障碍（相对危险度，RR为3.6；95%可信区间，CI为1.8-7.2）、血压异常（RR为2.3,95% CI为1.2-4.7）和心力衰竭（RR为2.9,95% CI为1.6-5.3）。每天接受少于10mg静脉注射硫酸吗啡当量的患者比接受更多止痛药的患者更容易发生谵妄（RR 5.4, 95% CI 2.4-12.3）。与接受其他阿片类镇痛药的患者相比，接受哌替啶的患者发生谵妄的风险增加（RR 2.4, 95% CI 1.3-4.5）。在认知完整的患者中，剧烈疼痛显著增加谵妄的风险（RR 9.0, 95% CI 1.8-45.2）。结论：临床医生可以根据入院资料识别髋部骨折后谵妄的高危患者。避免使用阿片类药物或使用极低剂量的阿片类药物会增加谵妄的风险。认知完整的疼痛未得到充分治疗的患者发生谵妄的可能性是疼痛得到充分治疗的患者的9倍。治疗不足的疼痛和不适当的镇痛似乎是危险因素谵妄在虚弱的老年人。
BACKGROUND Delirium and pain are common following hip fracture. Untreated pain has been shown to increase the risk of delirium in older adults undergoing elective surgery. This study was performed to examine the relationship among pain, analgesics, and other factors on delirium in hip fracture patients. METHODS We conducted a prospective cohort study at four New York hospitals that enrolled 541 patients with hip fracture and without delirium. Delirium was identified prospectively by patient interview supplemented by medical record review. Multiple logistic regression was used to identify risk factors. RESULTS Eighty-seven of 541 patients (16%) became delirious. Among all subjects, risk factors for delirium were cognitive impairment (relative risk, or RR, 3.6; 95% confidence interval, or CI, 1.8-7.2), abnormal blood pressure (RR 2.3, 95% CI 1.2-4.7), and heart failure (RR 2.9, 95% CI 1.6-5.3). Patients who received less than 10 mg of parenteral morphine sulfate equivalents per day were more likely to develop delirium than patients who received more analgesia (RR 5.4, 95% CI 2.4-12.3). Patients who received meperidine were at increased risk of developing delirium as compared with patients who received other opioid analgesics (RR 2.4, 95% CI 1.3-4.5). In cognitively intact patients, severe pain significantly increased the risk of delirium (RR 9.0, 95% CI 1.8-45.2). CONCLUSIONS Using admission data, clinicians can identify patients at high risk for delirium following hip fracture. Avoiding opioids or using very low doses of opioids increased the risk of delirium. Cognitively intact patients with undertreated pain were nine times more likely to develop delirium than patients whose pain was adequately treated. Undertreated pain and inadequate analgesia appear to be risk factors for delirium in frail older adults.