人工关节置换术后严重内科并发症分析

Analyses of major medical complications after total joint arthroplasty

[目的]调查人工髋、膝关节置换术后严重内科并发症的特点和危险因素,为人工关节置换术的围手术期管理和临床决策提供参考。[方法]研究对象为2013年5月1日~12月31日期间行初次人工髋或膝关节置换术的患者。采集患者的基本信息、病史、麻醉、手术及术后并发症情况,分析术后并发症的特点和危险因素。[结果]共有1 050例患者行1 188个初次人工髋或膝关节置换术。患者的平均年龄为（59.9±11.9）岁,70.1%的患者为女性。人工关节置换术后严重内科并发症的发生率为4.8%,包括心梗（0.1%）、心绞痛（1.9%）、心律失常（1.2%）、心衰（0.4%）、脑梗（0.6%）、肺栓塞（0.2%）和慢性阻塞性肺病急性加重（0.4%）。90%的严重内科并发症发生于术后4 d内。年龄≥70岁（OR：2.49,95%CI：1.17~5.29）和ASAⅢ级（OR：15.97,95%CI：2.66~95.79）是严重内科并发症的危险因素。[结论]人工髋、膝关节置换术后会出现严重的内科并发症。要重视患者的围手术期管理,尤其是高龄和高ASA分级的患者。人工关节置换术后住院日不宜过短。

[Objective] The purpose of this study was to investigate the characteristics and risk factors of major medical complications after total hip and knee arthroplasties,so as to help perioperative management and clinical decision- making.[Methods] All patients undergoing primary total hip arthroplasty or total knee arthroplasty from May 2013 to Dec 2013 were included in this study. Data including demographic information,history,anesthesia,surgery,and postoperative complications were recorded. Analyses of the characteristics and risk factors of major medical complications were performed. [Results] A total of 1188 primary total hip and knee arthroplasties had been performed in 1050 patients. The average age of the patients was（ 59. 9± 11. 9） years. 70. 1% of the patients were female. 4. 8% of the patients experienced major medical complications,including myocardial infarction（ 0. 1%）,angina pectoris（ 1. 9%）,arrhythmia（ 1. 2%）,heart failure（ 0. 4%）,stroke（ 0. 6%）,pulmonary embolism（ 0. 2%） and acute exacerbation of chronic obstructive pulmonary disease（ 0. 4%）. 90% of the major medical complications occurred within 4 days after the surgery. Two independent predictors of postoperative major medical complications included patient＇s age（ 70 years or elder）（ odds ratio [OR] = 2. 49; 95% confidence interval [CI] = 1. 17 to5. 29） and American Society of Anesthesiologists（ ASA） classification of 3（ OR = 15. 97; 95% CI = 2. 66 to 95. 79）.[Conclusion] Some major medical complications occur after total hip and knee arthroplasties. Perioperative management is important,especially for those patients with older age or higher ASA classification. The postoperative hospital stay period after total joint arthroplasty should not be too short.