老年髋部骨折围手术期并发症危险因素评估

Assessment of risk factors for perioperative complications of senile hip fracture

目的研究老年髋部骨折围手术期并发症相关危险因素。方法对2008年1月～2012年8月于我院因髋部骨折行手术治疗的571例老年患者临床资料进行回顾性研究,男性187例,女性384例;平均年龄73.75岁。37.8%患者合并高血压病,18.3%合并糖尿病,12.3%合并冠心病。收集并分析可能导致围手术期并发症相关危险因素,运用二分类Logistic多重逐步回归分析法;采用SPSS13.0进行统计分析,P<0.05有统计学意义。结果围手术期并发症110例,占总数的19.26%。通过统计学分析,年龄(OR=0.6,95%CI 0.4～0.9)、术前合并高血压(OR=1.6,95%CI 1.2～2.1)、术前合糖尿病(OR=0.3,95%CI0.1～0.6)、心功能不全(OR=1.8,95%CI 1.1～2.9)、美国麻醉师协会(ASA)分级≥3级(OR=2.2,95%CI1.2～4.3)、WBC计数升高(OR=1.8,95%CI 1.0～3.0)、低钾(OR=2.7,95%CI 1.3～5.5)、低白蛋白(OR=1.6,95%CI 1.0～2.5)、全身麻醉(OR=1.6,95%CI 1.1-2.3)、手术时间(OR=1.9,95%CI 1.2-3.1)为老年髋部骨折围手术期内并发症危险因素(P<0.05)。结论明确术前及术中危险因素,在预防和减少围手术期并发症过程中具有重要的作用。

Objective To explore the risk factors of postoperative complications in senile hip fracture pa-tients during the peri-operative period .Methods A total of 571 cases of senile hip fracture were collected from the Department of Orthopaedics in our hospital from Jan .2008 to Aug.2012.There were 187 males and 384 females, with an average age of 73.75 years.37.8% patients were associated with hypertension,18.3% diabetes,and 12.3%coronary heart disease .The related risk factors which may cause perioperative complications were collected and analyzed using multiple stepwise logistic regression analysis .SPSS 13.0 was used for statistical analysis .P〈0.05 was considered to be statistically significant .Results Totally 110 patients were found peri-operative compli-cations,accounting for 19.2%.Through the statistical analysis ,age,preoperative hypertension ,preoperative diabe-tes,cardiac dysfunction,ASA grade ≥3 levels,increased WBC count,low potassium,low albumin,general anesthe-sia,operation time≥3 hours were closely correlated with the postoperative complication in senile hip fracture pa-tients（P〈0.05）.Conclusion Identifying the pre-operative and peri-operative risk factors plays an important role in the prevention and reduction of perioperative complications .