骨科术后谵妄风险分层与多模式睡眠干预的临床效果评价OA

Objective To evaluate the preventive effectiveness of risk stratification combined with a multimodal sleep interventions on postoperative delirium in orthopedic patients.Methods A prospective randomized controlled trial was conducted,110 patients from Nanjing Medical University Affiliated Suzhou Hospital undergoing surgery for multiple fractures were randomly assigned to an observation group(n=55)or a control group(n=55).The observation group received individualized multimodal sleep interventions(pharmacotherapy,environmental optimization,cognitive training)based on preoperative risk stratification(high-risk,medium-risk,low-risk),while the control group received routine care.Primary outcomes were delirium incidence,duration,and sleep quality.Results The delirium incidence in the observation group was 16.4%(9/55),significantly lower than 34.5%(19/55)in the control group(P=0.016).Delirium duration was shorter in the observation group((24.5±6.8)h vs.(38.2±9.1)h,P<0.001)).Sleep quality(RCSQ:(7.6±1.2)vs.(5.3±1.5))and comfort scores((8.1±1.0)vs.(6.2±1.3))swere significantly better in the observation group(all P<0.001).Daily nursing time was longer in the observation group((28.5±4.3)min/d vs.(12.1±2.7)min/d).Conclusions Preoperative risk stratification combined with a multimodal sleep interventions effectively reduces the incidence and duration of postoperative delirium and improves sleep quality and comfort in patients after major orthopedic surgery,supporting its clinical applicability.