2021 年第 7 期 第 16 卷

简易智力状态检查量表评分对不同年龄髋部骨折老年患者术后谵妄的预测价值

Predictive value of mini mental state examination scale score for postoperative delirium in elderly patients with hip fracture of different ages

作者：陈小妹张余芳

英文作者：Chen Xiaomei Zhang Yufang

单位：海南医学院第二附属医院东湖分院麻醉科，海口570311

英文单位：Department of Anesthesiology Donghu Branch of the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：髋部骨折；简易智力状态检查量表；老年；术后谵妄

英文关键词：Hipfracture;Minimentalstateexaminationscale;Elderly;Postoperativedelirium

• 摘要：

• 目的 探讨术前简易智力状态检查量表（MMSE）评分对不同年龄髋部骨折老年患者术后谵妄的预测价值。方法 选取2018年1月至2020年9月在海南医学院第二附属医院住院并行手术治疗的髋部骨折老年患者143例，其中年龄>80岁71例，≤80岁72例。观察术后谵妄发生率，比较谵妄与非谵妄患者的临床特征与术前MMSE评分。采用多因素Logistic回归方法分析不同年龄髋部骨折老年患者术后谵妄的影响因素，采用Spearman相关性分析方法探讨髋部骨折老年患者术前MMSE评分与术后不同时点记忆谵妄评定量表评分的相关性，并用受试者工作特征(R0C)曲线及曲线下面积（AUC）分析术前MMSE评分对不同年龄髋部骨折老年患者术后谵妄的预测价值。结果 髋部骨折老年患者术后谵妄的发生率为28.0%（40/143），年龄>80岁患者谵妄发生率明显高于≤80岁患者［38.0%（27/71）比18.1%（13/72）， χ2=7.078，P=0.008］。多因素Logistic回归分析结果显示，经校正其他影响因素后，在所有患者、>80岁患者和≤80岁患者中，术前MMSE评分均为髋部骨折老年患者术后谵妄的独立影响因素（P＜0.01或P＜0.05）。Spearman 相关性分析结果显示，在所有患者中，术前MMSE评分均与术后第1、2、3天记忆谵妄评定量表评分呈显著负相关（均P＜0.01）。ROC曲线分析结果显示，在>80岁患者中，术前MMSE评分最佳截断值为21分，对术后谵妄的敏感度为85.2%，特异度为63.6%，AUC为0.775；在≤80岁患者中，术前MMSE评分最佳截断值为18分，AUC为0.859，敏感度为69.2%，特异度为93.3%。结论 术前MMSE评分对髋部骨折老年患者术后谵妄有一定预测价值，在>80岁患者中，术前MMSE评分最佳截断值为21分；在≤80岁患者中，术前MMSE评分最佳截断值为18分。

• Objective To explore the predictive value of preoperative mini mental state examination scale (MMSE) score for postoperative delirium in elderly patients with hip fracture of different ages. Methods From January 2018 to September 2020, 143 elderly patients with hip fracture undergoing surgical treatment hospitalized in the Second Affiliated Hospital of Hainan Medical University were selected, including 71 cases aged >80 years and 72 cases aged ≤80 years. The incidence of postoperative delirium was observed. The clinical characteristics and preoperative MMSE score between delirium and non-delirium patients were compared. The influencing factors for postoperative delirium in elderly patients with hip fracture of different ages were analyzed by multivariate Logistic regression analysis model, the correlation between preoperative MMSE score and postoperative memorial delirium assessment scale(MDAS) score at different time points in elderly patients with hip fracture were analyzed by Spearman correlation analysis method, and the predictive value of preoperative MMSE score for postoperative delirium in elderly patients with hip fracture of different ages was analyzed by the receiver operating characteristic(ROC) curve and the area under the curve(AUC). Results The incidence of postoperative delirium in elderly patients with hip fracture was 28.0%(40/143). The incidence of delirium in patients aged >80 years was significantly higher than that in patients aged ≤80 years［38.0%（27/71） vs 18.1%（13/72）, χ2=7.078, P=0.008］. Multivariate Logistic regression analysis showed that after adjusting for other influencing factors, preoperative MMSE score was an independent influencing factor of postoperative delirium in all elderly patients, patients aged >80 years and patients aaged≤80 years with hip fracture(P<0.01 or P＜0.05). Spearman correlation analysis showed that the preoperative MMSE score was significantly negatively correlated with the MDAS score on the 1st, 2nd and 3rd days after operation in all patients(all P<0.01). ROC curve showed that the optimal cut-off value of preoperative MMSE score associated with postoperative delirium in patients aged >80 years was 21, with a sensitivity of 85.2% and a specificity of 63.6%， and the AUC was 0.775. In patients aged ≤80 years, the optimal cut-off value of preoperative MMSE score associated with the postoperative delirium was 18, and the AUC was 0.859, with a sensitivity of 69.2% and a specificity of 93.3%. Conclusions Preoperative MMSE score has a certain predictive value for postoperative delirium in elderly patients with hip fracture. In patients aged >80 years, the optimal cut-off value of preoperative MMSE score is 21. In patients aged ≤80 years, the optimal cut-off value of preoperative MMSE score is 18.