healthcareЗдравоохранение. HealthcareHealthcare1027-7218Republican Scientific and Practical Center for Medical Technologies, Informatization, Management and Health Economics10.65249/1027-7218-2026-6-59-73healthcare-310Research ArticleНЕПРЕРЫВНОЕ ПРОФЕССИОНАЛЬНОЕ РАЗВИТИЕCONTINUOUS PROFESSIONAL DEVELOPMENTПослеоперационный делирий у ортогериатрического пациента: факторы риска и современные подходы к профилактикеPostoperative delirium in an orthogeriatric patients: risk factors and modern approaches to preventionhttps://orcid.org/0009-0000-2823-8414НевмержицкаяО. С.NevmerzhitskaiaO.

Невмержицкая Ольга Сергеевна – врач – анестезиолог-реаниматолог

Ул. Л. Кижеватова, 58, 220024, г. Минск Сл. тел. +375 17 287-00-16

https://orcid.org/0000-0001-7690-0871СветлицкаяО. И.SvetlitskayaO.

Светлицкая Ольга Ивановна

Минск

Городская клиническая больница скорой медицинской помощи; Белорусский государственный медицинский университетBelarusГородская клиническая больница скорой медицинской помощиBelarus202601082026065973Copyright © Невмержицкая О.С., Светлицкая О.И., 20262026Невмержицкая О.С., Светлицкая О.И.Nevmerzhitskaia O., Svetlitskaya O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://healthcare.ejournal.by/jour/article/view/310

Цель исследования. На основании анализа литературных источников определить основные факторы риска послеоперационного делирия у возрастных пациентов с переломами шейки бедренной кости при эндопротезировании тазобедренного сустава и обосновать современные подходы к его профилактике.Материал и методы. Настоящая работа представляет собой нарративный обзор с элементами систематизации данных современной литературы (PubMed, Scopus, eLibrary, Cochrane Library) за период 2015–2025 гг. по ключевым словам: hip fracture, delirium, risk factors, elderly, perioperative care, regional anesthesia, PENG-block. Включены метаанализы, систематические обзоры, рандомизированные контролируемые исследования и проспективные когортные исследования.Результаты. Частота послеоперационного делирия после эндопротезирования тазобедренного сустава по поводу перелома шейки бедренной кости достигает 40–60 %. Выделены модифицируемые факторы риска: анемия, электролитные нарушения, гипоальбуминемия, полипрагмазия, длительное предоперационное голодание, интраоперационная гипотензия, глубокая анестезия, гипотермия, выраженный болевой синдром, высокие дозы опиоидов, поздняя активизация. Ключевая роль в профилактике отводится мультимодальной опиоид-сберегающей аналгезии с регионарным компонентом (PENG-блок), которая снижает потребление опиоидов на 50–70 %, риск послеоперационного делирия – на 25–35 %. Применение дексмедетомидина у пациентов высокого риска уменьшает частоту послеоперационного делирия на 40–50 %. Внедрение комплексных мультидисциплинарных протоколов позволяет снизить частоту послеоперационного делирия на 30–40 %.Заключение. Послеоперационный делирий при эндопротезировании тазобедренного сустава у возрастных пациентов с переломами шейки бедренной кости является многофакторным осложнением, профилактика которого должна основываться на коррекции модифицируемых факторов риска с использованием регионарных блокад, дексмедетомидина, ранней активизации и комплекса немедикаментозных вмешательств.

Objective. Based on an analysis of the literature, to identify the main risk factors for postoperative delirium (POD) in elderly patients with femoral neck fractures undergoing hip arthroplasty and to substantiate contemporary approaches to its prevention.Materials and methods. A systematic review of domestic and international literature published between 2015 and 2025 was conducted using PubMed, Scopus, eLibrary, and the Cochrane Library databases. The following keywords were used: hip fracture, delirium, risk factors, elderly, perioperative care, regional anesthesia, and PENG-block. Metaanalyses, systematic reviews, randomized controlled trials, and prospective cohort studies were included.Results. The incidence of POD after hip arthroplasty for femoral neck fractures reaches 40–60 %. The following modifiable risk factors were identified: anemia, electrolyte imbalance, hypoalbuminemia, polypharmacy, prolonged preoperative fasting, intraoperative hypotension, deep anesthesia, hypothermia, severe pain syndrome, high opioid doses, and delayed mobilization. A key role in prevention is attributed to multimodal opioid-sparing analgesia with a regional component (PENG-block), which reduces opioid consumption by 50–70 % and lowers the risk of POD by 25–35 %. The use of dexmedetomidine in high-risk patients decreases the incidence of POD by 40–50 %. Implementation of comprehensive multidisciplinary protocols can reduce POD incidence by 30–40 %.Conclusions. POD in elderly patients with femoral neck fractures undergoing hip arthroplasty is a multifactorial complication, the prevention of which should be based on correction of modifiable risk factors using regional anesthesia, dexmedetomidine, early mobilization, and a complex of non-pharmacological interventions.

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The authors declare that there are no conflicts of interest present.