老年髋部骨折术后肺部并发症的危险因素分析

Risk factor analysis for postoperative pulmonary complications in elderly hip fractures

目的探讨引起老年髋部骨折患者术后肺部并发症(PPC)的危险因素。方法回顾性分析广东省江门市五邑中医院骨伤科二区在2012年6月至2015年6月收治的符合纳入标准的老年髋部骨折患者418例,其中男性182例(43.5%),女性236例(56.5%),年龄75~99岁,平均(82±6)岁,根据是否出现PPC进行分组,记录并比较两组患者的年龄、性别、手术方式、麻醉方式、术前并存病、待术时间、血气分析和肺通气功能情况,采用多因素logistic回归分析老年髋部骨折术后并发症的相关危险因素。结果单因素分析示组间年龄x^2=12.473,P=0.001)、麻醉方式x^2=36.721,P<0.001)、术前并存病x^2=16.724,P<0.001)、待术时间(t=4.872,P=0.041)、血气分析x^2=26.341,P<0.001)、肺通气功能x^2=35.431,P<0.001)差异有统计学意义。多因素Logistic回归分析示年龄>85岁组PPC发生率高于年龄<85岁组,OR值为3.673(95%CI:1.684,7.615);待术3~4 d组和5~7 d组和PPC发生率高于1~2 d组(OR:13.349,95%CI:5.391~23.819;OR:16.579,95%CI:6.324~37.324);术前并存病≥3组PPC的发生率高于≤2组(OR:4.069,95%CI:2.024~8.182);全麻组PPC发生率高于椎管内麻醉组(OR:3.579,95%CI:1.848~8.608);血气分析异常组PPC发生率高于血气分析正常组(OR:9.842,95%CI:2.338~7.421);肺通气功能异常组PPC发生率高于肺通气功能正常组(OR:11.384,95%CI:3.652~9.352)。结论高龄、术前并存病≥3种、待术时间长、全身麻醉以及血气分析异常和肺通气功能异常是老年髋部骨折患者发生PPC的危险因素。

Objective To evaluate the risk factors of postoperative pulmonary complications in elderly hip fracture patients. Methods Four hundred and eighteen hip fracture patients treated in the second department of orthopaedic Wuyi TCM Hospital of Jiangmen Guangdong from June 2012 to June 2015 were included in this retrospective study. There were 182 males, 236 females with an average of 82 ± 6 years(range, 75- 99 years). Patients were divided into non- PPC and PPC group. Age, gender, surgery approach,anesthesia method, preoperative comorbidity, time interval from injury, blood gas analysis, pulmonary ventilation function were compared between two groups, Mutil- factor logistic regression analysis was applied to investigate risk factors of postoperative pulmonary complications in elderly hip fractures. Results There was significant difference on agex^2=12.473, P=0.001), anesthesia methodx^2=36.721, P<0.001),preoperative comorbidityx^2=16.724, P<0.001), time interval from injury(t=4.872, P=0.041), the blood gas analysisx^2=26.341, P<0.001), pulmonary ventilation functionx^2=35.431, P<0.001) using single factor analysis. Multi- factor Logistic regression analysis showed that PPC occurrence rate in patients over 85 years was higher than that in patients under 85 years, and the OR value was 3.673(95% CI: 1.684- 7.615). Rate of PPC occurrence in 3-4 d group and 5-7 d group from injury was both higher than that in 1-2 d group, OR value was 13.349(95% CI: 5.391- 23.819) and 16.579(95% CI: 6.324- 37.324). Incidence of PPC in more than 2preoperative comorbidities group was higher than that in less than 3 preoperative comorbidities group, OR value was 4.069(95% CI: 2.024-8.182). Generalanesthesia group was higher than the intraspinal anesthesia group, OR value was 3.579(95% CI: 1.848- 8.608). The blood gas analysis show that the PPC occurrence rate in the abnormal group was higher than the normal group, OR value was 9.842(95% CI: 2.338-7.421);PPC occurrence rate in the abnormal Pulmonary ventilation function group was higher than the normal one,OR value was 11.384(95% CI: 3.652- 9.352). Conclusion Advanced age, more preoperative comorbidity,prolonged time interval from injury, general anesthesia, abnormal blood gas analysis and abnormal pulmonary ventilation function are the risk factors for PPC in elderly patients with hip fracture.