影响老年髋部骨折患者术后1年死亡率的因素分析

Risk factors for mortality one year after hip fracture surgery in elderly patients

[目的]回顾性分析影响老年髋部骨折患者术后1年死亡率的危险因素。[方法]2010年1月～2012年1月，130例年龄〉70岁的髋部骨折患者，全部采用人工全髋关节置换术或人工股骨头置换术治疗。分析的因素包括患者的性别、年龄、受伤至入院时间、受伤至手术时间、合并症数目、ASA分级、入院血清白蛋白含量、入院淋巴细胞计数、入院血红蛋白含量以及输血量。手术后随访1年，或者随访至患者死亡。有效随访92例，男28例，女64例。生存率的单因素分析采用Fisher精确检验，多因素分析采用多因素Cox比例风险模型。[结果]92例患者，随访1年内死亡8例，存活84例，院内死亡2例。单因素分析患者术后1年死亡的危险因素包括受伤至人院时间〉5d，ASA分级Ⅲ、Ⅳ级，入院血清白蛋白含量〈3．5g／d1，入院血红蛋白含量〈120g／L以及输血量〉1000ml；86岁以上患者的死亡率（20．0％）高于70～85岁患者（5．6％），受伤至手术时间〉7d的患者死亡率（15．8％）高于〈7d的患者（3．0％），但无统计学意义（分别为P=0．065和P=0．061）。多因素分析显示，ASA分级Ⅲ、Ⅳ级和入院血清白蛋白减低是老年髋部骨折患者死亡的独立危险因素。[结论]ASA分级Ⅲ、Ⅳ级和入院血清白蛋白减低是老年髋部骨折患者术后1年死亡的独立危险因素。

[ Objective ] To retrospectively assess the risk factors for mortality 1 year after surgical intervention for fracture of the hip in elderly patients. [ Method] The study included 130 elderly patients （ age, ≥70 years） ,who underwent either total hip arthroplasty or bipolar arthroplasty for fracture of the hip between January 2010 and January 2012. The factors investigated were gender, age, the time interval from fracture to admission, the time interval from fracture to surgery, eomorbidities, American Soci-ety of Anaesthesiologists （ASA） rating of operative risk, serum albumin and hemoglobin levels at admission, total lymphocyte count at admission, and allogeneic blood transfusion. The patients were followed for 1 year after surgery, or until death. Survival data were available for 92 patients （64 women ,28 men） at 1 year. Comparison of the categorical variables between the patient groups was performed using the Fisherg exact test. The Cox regression analysis was performed to analyse the confounding effects of various factors on 1-year mortality. [ Result] Of the 92 patients in the study,84 survived. There were 2 in-hospital deaths. In the univariate analysis of 1-year mortality, time interval from fracture to admission ≥5 days, ASA scores of Ⅲ and Ⅳ, low serum albumin at admission,low hemoglobin at admission, and allogeneic blood transfusion 〉 1000 mL were significantly associated with higher mortality. In the multivariate analysis, 1-year mortality was significantly associated with ASA scores of Ⅲ and Ⅳ, and low serum albumin at admission. [ Conclusion ] Our study confirms that a high ASA score and low serum albumin level at admis-sion are significant factors in the assessment of 1-year mortality in elderly patients with hip fractures.