老年重症糖尿病高危患者髋部骨折围术期风险分析

Risk analysis of severe diabetic senile patients with hip fracture

目的探讨老年重症糖尿病高危患者髋部骨折围术期的风险评估和治疗策略。方法回顾性调查1998年到2007年老年重症糖尿病高危患者合并髋部骨折85例,对术前血糖水平分期评估,检测不同血糖水平的糖尿病(DM)患者手术后FPG、2hPG,50例非糖尿病髋部骨折患者作为对照,对术前不同血糖水平患者术后低血糖、酮症酸中毒、切口感染、肺炎、泌尿系统感染和深静脉血栓以及肺栓塞等并发症进行统计分析和比较。结果 85例老年糖尿病合并髋部骨折患者,随访8个月(5～13个月),83例患者安全渡过围术期,2例死于肺栓塞。较高血糖DM组酮症酸中毒、泌尿系统感染和血栓术后并发症的发病率高于较低血糖DM组。结论应重视老年重症糖尿病高危患者合并髋部骨折围术期的评估,积极控制血糖能够预防酮症酸中毒、感染和血栓等术后并发症,提高患者生活质量。

Objective To investigate the peri-operative risks and treatment for severe diabetic senile patients with hip fracture. Methods A total of 85 severe diabetic senile patients with hip fracture who were admitted from were retrospectively reviewed. Their blood glucose level was examined preoperatively. The FPG and 2hPG were examined according to their different blood glucose levels post-operatively. Fifty non-diabetic patients with hip fracture were the control group. Post-operative complications such as hypoglycemia, ketoacidosis, wound infection, pneumonia , urinary system infection, deep vein thrombosis（DVT） and pulmonary embolism（PE） were statistically analysed and compared. Results Eighty-five severe diabetic senile patients with hip fracture were followed up for 8 months in average（5-13months）. Eighty-three patients survived the peri-operation period and 2 patients died of PE. The risk of ketoaeidosis, urinary system infection and thrombosis is significantly higher in the DM group with higer blood glucose group than that in the DM group with lower blood glucose. Conclusions The peri-operation assessment of blood glucose should be emphasized among the diabetic senile patients with hip fracture. To actively control the blood glucose level may protect the patients from ketoaeidosis, urinary system infection and thrombosis, and increase the life quality.