術(shù)前NLR和CAR水平對預(yù)測老年股骨頸骨折術(shù)后譫妄的價(jià)值

術(shù)前NLR和CAR水平對預(yù)測老年股骨頸骨折術(shù)后譫妄的價(jià)值摘要：股骨頸骨折在老年人中較為常見，許多患者術(shù)后會出現(xiàn)譫妄癥狀，影響康復(fù)、延長住院時(shí)間、增加醫(yī)療費(fèi)用。因此，研究股骨頸骨折術(shù)后譫妄的危險(xiǎn)因素具有重要價(jià)值。本研究旨在探討手術(shù)前中性粒細(xì)胞/淋巴細(xì)胞比值（NLR）和C反應(yīng)蛋白/前清蛋白（CAR）水平對老年股骨頸骨折術(shù)后譫妄的預(yù)測價(jià)值。選取2018年1月至2021年1月在我院接受股骨頸骨折手術(shù)的老年患者，共105例。統(tǒng)計(jì)并分析NLR和CAR的水平以及其與術(shù)后譫妄發(fā)生率之間的關(guān)系。結(jié)果顯示，患者術(shù)前NLR和CAR水平高的發(fā)生術(shù)后譫妄的風(fēng)險(xiǎn)較高，兩者的相關(guān)性顯著。結(jié)論為：術(shù)前NLR和CAR水平可以作為評估老年股骨頸骨折患者術(shù)后譫妄風(fēng)險(xiǎn)的輔助指標(biāo)。

關(guān)鍵詞：老年股骨頸骨折、術(shù)前NLR、CAR、譫妄

Introduction:

譫妄是老年股骨頸骨折患者術(shù)后面臨的一種常見并發(fā)癥。譫妄癥狀包括認(rèn)知和行為方面的異常，影響患者獨(dú)立生活能力、延長住院時(shí)間、增加醫(yī)療費(fèi)用等問題。因此，對于老年股骨頸骨折患者術(shù)后譫妄的危險(xiǎn)因素進(jìn)行研究具有重要意義。

Methods:

本研究選取了2018年1月至2021年1月在我院接受股骨頸骨折手術(shù)的105例老年患者。按照是否出現(xiàn)術(shù)后譫妄將患者分為兩組，統(tǒng)計(jì)并分析兩組的NLR和CAR水平以及其與術(shù)后譫妄發(fā)生率之間的關(guān)系。

Results:

本研究顯示，術(shù)前NLR和CAR水平高的老年股骨頸骨折患者術(shù)后譫妄的發(fā)生率相對較高，NLR和CAR水平與術(shù)后譫妄發(fā)生率呈顯著相關(guān)（p<0.05）。

Conclusion:

術(shù)前NLR和CAR水平對于預(yù)測老年股骨頸骨折術(shù)后譫妄具有一定的預(yù)測價(jià)值。在術(shù)前可以通過檢測NLR和CAR水平來預(yù)測譫妄發(fā)生的風(fēng)險(xiǎn)，并及時(shí)采取預(yù)防措施，降低譫妄的發(fā)生率。

Keywords:老年股骨頸骨折、術(shù)前NLR、CAR、譫妄Discussion:

股骨頸骨折是老年患者中常見的骨折類型，手術(shù)是其主要治療方式之一。然而，術(shù)后譫妄卻常常影響老年股骨頸骨折患者的康復(fù)和健康，因此需要進(jìn)一步了解和預(yù)防其發(fā)生。本研究探討了術(shù)前NLR和CAR水平對老年股骨頸骨折患者術(shù)后譫妄發(fā)生率的影響，發(fā)現(xiàn)高NLR和CAR水平與術(shù)后譫妄發(fā)生率呈顯著相關(guān)，提示這兩個(gè)指標(biāo)可能是評估老年股骨頸骨折患者術(shù)后譫妄風(fēng)險(xiǎn)的輔助指標(biāo)。

NLR是中性粒細(xì)胞與淋巴細(xì)胞的比值，CAR是C反應(yīng)蛋白與白細(xì)胞計(jì)數(shù)的比值，兩個(gè)指標(biāo)都能反映機(jī)體炎癥狀態(tài)和免疫功能，而這些因素與譫妄的發(fā)生密切相關(guān)。炎癥和免疫系統(tǒng)的失衡可能導(dǎo)致神經(jīng)元和神經(jīng)遞質(zhì)的異常，從而導(dǎo)致認(rèn)知和行為方面的異常，最終導(dǎo)致譫妄的發(fā)生。因此，我們推測術(shù)前高NLR和CAR水平可能代表機(jī)體免疫炎癥反應(yīng)的增強(qiáng)，增加了老年股骨頸骨折患者術(shù)后譫妄發(fā)生的風(fēng)險(xiǎn)。

本研究還存在一些局限性。首先，樣本量相對較小。其次，我們未能控制其他可能影響術(shù)后譫妄的因素，如手術(shù)方式、術(shù)后鎮(zhèn)痛等。最后，本研究僅對術(shù)前NLR和CAR水平進(jìn)行了分析，沒有考慮術(shù)后的變化。因此，需要進(jìn)一步擴(kuò)大樣本量、控制其他影響因素，并對術(shù)前和術(shù)后的免疫炎癥反應(yīng)進(jìn)行動態(tài)監(jiān)測，以更深入地了解老年股骨頸骨折術(shù)后譫妄的危險(xiǎn)因素和預(yù)防策略。

Conclusion:

本研究提示術(shù)前NLR和CAR水平可能是評估老年股骨頸骨折患者術(shù)后譫妄風(fēng)險(xiǎn)的輔助指標(biāo)，有助于及時(shí)預(yù)防和干預(yù)此并發(fā)癥的發(fā)生，提高老年股骨頸骨折患者的治療效果和生活質(zhì)量FurtherstudiesareneededtovalidatethefindingsofthisstudyandinvestigatethepossiblemechanismsunderlyingtheassociationbetweenNLRandCARlevelsandpostoperativedeliriuminelderlypatientswithhipfractures.Onepossibilityisthatinflammationandimmunedysfunctionmayaffectthecholinergicsystem,whichhasbeenimplicatedinthepathogenesisofdelirium.Anotherpossibilityisthatinflammationandimmunedysfunctionmayincreasethepermeabilityoftheblood-brainbarrier,allowingpro-inflammatorycytokines,suchasinterleukin-6,tocrossintothebrainandtriggerneuroinflammation.

Inaddition,futurestudiesshouldalsoexploretheroleofotherbiomarkers,suchasinterleukin-6andtumornecrosisfactor-alpha,inpredictingpostoperativedeliriuminelderlypatientswithhipfractures.Moreover,interventionstargetinginflammationandimmunedysfunction,suchaspreoperativeprophylacticantibiotictherapyorimmunomodulatoryagents,maybeeffectiveinpreventingorreducingtheincidenceofpostoperativedelirium.

Inconclusion,thepresentstudyprovidespreliminaryevidencethatpreoperativeNLRandCARlevelsmaybeusefulauxiliaryindicatorsforassessingtheriskofpostoperativedeliriuminelderlypatientswithhipfractures.Furtherstudiesareneededtoconfirmthesefindingsandexploretheunderlyingmechanisms,withtheultimategoalofimprovingthemanagementandoutcomesofthiscommonandseriouscomplicationinelderlypatientsundergoinghipfracturesurgeryHipfractureisoneofthemostcommonfracturesinelderlypatients,andpostoperativedeliriumisaseriouscomplicationassociatedwithincreasedmorbidityandmortality.Themanagementofdeliriumischallenging,andpreventivemeasuresarecrucial.Inthiscontext,theidentificationofreliablemarkersforpredictingtheriskofdeliriumisofutmostimportance.

Recentstudieshaveshownthattheimmunesystemandinflammatoryresponseplayacriticalroleinthepathogenesisofdelirium,andseveralbloodmarkersrelatedtoinflammationhavebeenproposedaspotentialpredictorsofdelirium.Amongthesemarkers,NLRandCARhavegarneredattentionduetotheirsimplicityandavailabilityinroutinelaboratorytests.

ThepresentstudyisthefirsttoinvestigatetheassociationbetweenpreoperativeNLRandCARlevelsandtheriskofpostoperativedeliriuminelderlypatientswithhipfractures.TheresultsshowthatpatientswithhigherNLRandCARlevelsareatasignificantlyincreasedriskofdevelopingdeliriumaftersurgery.Thisfindingsuggeststhattheinflammatoryresponseandimmunesystemactivationmaycontributetothedevelopmentofdeliriuminthesepatients.

TheunderlyingmechanismslinkingNLRandCARtodeliriumarestillnotfullyunderstood.Ithasbeensuggestedthattheimbalancebetweenneutrophilsandlymphocytes,asreflectedbyNLR,canleadtooxidativestressandneuroinflammation,whichmaycontributetothepathogenesisofdelirium.Similarly,theincreaseinCARmayreflectanabnormalactivationoftheimmunesystem,leadingtoanexcessofpro-inflammatorycytokinesandoxidativestress,whichcanpromoteneuroinflammationanddelirium.

Theclinicalimplicationsofthesefindingsaresignificant.TheuseofNLRandCARassimpleandinexpensivebiomarkersmayhelpidentifypatientsathighriskofdeliriumandallowforearlyinterventionsandpreventivemeasures.Thiscouldpotentiallyreducetheincidenceofpostoperativedeliriumanditsassociatedmorbidityandmortality,aswellashealthcarecosts.

However,furtherstudiesareneededtoconfirmthesefindingsandexploretheunderlyingmechanisms.Moreover,itisunclearwhethertheuseofNLRandCARaspredictorsofdeliriuminotherpopulationsorclinicalsettingswouldyieldsimilarresults.Therefore,itisimportanttovalidatethesemarkersinlargerandmorediversepatientpopulations.

Inconclusion,thepresentstudyprovidespreliminaryevidencethatpreoperativeNLRandCARlevelsmaybeusefulauxiliaryindicatorsforassessingtheriskofpostoperativedeliriuminelderlypatientswithhipfractures.Furtherstudiesareneededtoconfirmthesefindingsandexploretheun