老年髋部骨折术后急性脑卒中发生的危险因素分析与预后分析

Risk factors and prognosis of postoperative stroke in elderly hip fracture patients

目的 探讨老年髋部骨折术后发生急性脑卒中的危险因素及对预后的影响. 方法 回顾性分析2006年10月至2010年12月收治的753例老年髋部骨折患者资料,男503例,女250例;年龄60～ 102岁,平均77.0岁.按照患者术后1周内有无发生脑卒中,将患者分为卒中组（17例,2.3％）和正常组（736例,97.7％）,比较两组患者的各项指标.应用多因素logistic回归分析确定老年髋部骨折术后发生急性脑卒中的独立危险因素,并分析预后. 结果 卒中组女性多于男性（58.8％vs41.2％）,卒中组患者多合并3种以上的内科合并症.心律失常病史、脑卒中病史、术中血压异常为髋部骨折患者术后发生急性脑卒中的独立危险因素（P＜0.05）.预后方面,卒中组的感染性并发症发生率（29.4％）高于正常组（5.8％）,卒中组ICU转入率（47.1％）高于正常组（10.8％）,差异均有统计学意义（P＜0.05）.两组患者术后1年功能康复评分差异均无统计学意义（P＞0.05）.卒中组患者的1年内死亡率为35.7％,远高于正常组患者的9.0％,两组患者的生存曲线差异显著（P＜0.01）. 结论 对于髋部骨折患者术后1周内发生脑卒中不容忽视.心律失常病史、脑卒中病史、术中血压异常为髋部骨折患者术后发生急性脑卒中的独立危险因素.术后发生脑卒中的患者住院时间延长,易发生感染等并发症,短期及长期预后差.

Objective To investigate the risk factors of postoperative stroke and their effects on the prognosis in elderly hip fracture patients.Methods The clinical records of 753 elderly patients with hip fracture were analyzed who had been admitted to our department from October 2006 to December 2010.They were 503 men and 250 women,60 to 102 years of age （average,77.0 years）.Seventeen of them（2.3%） had stroke one week postoperation and the other 736（97.7%） did not.The 2 groups were compared in gender,complications and mortality.Logistic regression was conducted to determine the independent risk factors of postoperative stroke in elderly patients with hip fracture.Results There were more females in the stroke group than in the normal group （58.8% versus 41.2%）.Most patients who suffered a stroke in the stroke group were complicated with more than 3 internal diseases.History of arrhythmia,history of stoke,intraoperative abnormal blood pressure were independent risk factors of acute stoke after hip fracture operation in elderly patients （P 〈 0.05）.The incidence of infective complications and the rate of being transferred to ICU （47.1%） in the stroke group （29.4%） were significantly higher than in the normal group （5.8% and 10.8%） （P 〈 0.05）.There were no significant differences in functional recovery one year postoperation between the 2 groups （P 〉 0.05）.The one-year mortality in the stroke group （35.7%） was significantly higher than in the normal group （9.0%）,showing significant difference in survival curve （P 〈 0.01）.Conclusions The risk of stroke within one week postoperation must not be neglected in elderly hip fracture patients.History of arrhythmia,history of stoke,and intraoperative abnormal blood pressure are independent risk factors of acute stoke after hip fracture operation in elderly patients.Patients who suffer a stroke the first week after operation usually have prolonged hospital stay,increased risk of infection,poor short-term and long-term prognosis.