Послеоперационный делирий у ортогериатрического пациента: факторы риска и современные подходы к профилактике

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.

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