高龄老年人髋部骨折合并内科疾病围手术期的治疗策略

Senile Hip Fracture with Internal Diseases Perioperative Treatment Strategies

目的:探讨高龄老年髋部骨折患者合并内科疾病在围手术期的治疗策略。方法:对合并有原发性高血压、2型糖尿病、冠状动脉粥样硬化性心脏病的高龄老年髋部骨折患者分别采用传统(请相应科室会诊)治疗(对照组190例)与同相应科室组织成立由骨科和相应内科组成的医疗合作团队联合治疗(观察组178例)。分别通过观察血压控制良好率、血糖控制良好率、冠状动脉粥样硬化性心脏病控制良好率CRIS(心脏危险指数系统)、围手术期死亡率、术前准备时间、平均住院时间、手术放弃率、心血管事件发生率、脑梗死发生率、深静脉血栓发生率等指标。结果:与对照组相比,观察组在血压控制良好率、血糖控制良好率、冠状动脉粥样硬化性心脏病控制良好率CRIS(心脏危险指数系统)分级上(均为2级)明显低于对照组(3～4级),而在围手术期死亡率、术前准备时间、平均住院时间、手术放弃率、心血管事件发生率、脑梗死发生率、深静脉血栓发生率等指标上明显低于对照组,差异有统计学意义(P<0.05)。结论:由医疗合作团队全程参与对合并有原发性高血压、2型糖尿病、冠状动脉粥样硬化性心脏病的高龄老年髋部骨折患者的治疗,对降低患者的手术风险,降低围手术期死亡率,促进患者术后的康复起到了很好的医疗保障,是一种值得借鉴的临床医学模式。

Objective To investigate the treatment strategy in patients with diseases in Department of internal medicine in peri operation period of elderly patients with hip fracture.Methods Patients were treated with traditional primary hypertension,type 2 diabetes,coronary heart disease in elderly patients with hip fracture combined（please the appropriate departments consultation） treatment（control group 190 cases） with the corresponding department organization set up a joint cooperative medical treatment team composed of Department of orthopedics and Department of internal medicine（observation group of 178 cases）.Respectively,through observation of blood pressure control rate of good blood glucose control,good rate of coronary atherosclerotic heart disease control rate of CRIS（cardiac risk index system）,operation mortality, preoperative preparation time,hospitalization time,give up the rate of operation, incidence of cardiovascular events,cerebral infarction, deep vein thrombosis rate index.Results Compared with control group,the observation group in blood pressure control rate of good,good blood sugar control rate,coronary atherosclerotic heart disease control rate of CRIS（cardiac risk index system） classification（both 2） was significantly lower than the control group （3- 4）,while in the peri operation period mortality, preoperative preparation the average hospitalization time,operation time, abandon rate,the rate of cardiovascular events,cerebral infarction,the occurrence rate of deep vein thrombosis were significantly lower than the control group,the difference was statistically significant（P 〈 0.05）.Conclusion By the medical team to participate in the treatment of patients with primary hypertension,type 2 diabetes,coronary heart disease in elderly patients with hip fracture on the merger,to reduce the operation risk of patients,reduce the operation mortality, promote postoperative rehabilitation has played a very good medical care,is a clinical medical model worthy of reference.