高龄髋部骨折患者围手术期死亡的危险因素分析

Risk factors of perioperative mortality in elderly patients with hip fracture

目的探讨高龄髋部骨折患者围手术期死亡的危险因素。方法回顾性分析2010年07月至2015年06月收治的高龄髋部骨折入住本院的且符合纳入及排除标准的患者206例(股骨粗隆间骨折112例、股骨颈骨折94例),根据是否发生死亡分为两组,将两组各项指标进行比较,使用SPSS 19.0软件对其进行二分类的非条件Logistic逐步回归模型分析。结果单因素分析提示心脑肺慢性病史、术后并发症、入院后24h内血白蛋白、脑钠肽(brain natriuretic peptide,BNP)、血糖、肌酐、动脉血p H值、动脉氧分压、APACHEII评分在两组间差异具有统计学意义;性别、年龄、手术方式、体温、呼吸、心率、平均动脉压、血红蛋白、血钠、血钾、麻醉方式两组间差异无统计学意义。多因素Logistic回归分析提示心脑肺慢性病史、术后并发症、BNP、APACHEII分值是高龄髋部骨折患者围手术期死亡的危险因素。结论 BNP及APACHE II评分作为高龄髋部骨折患者可能发生死亡的参考指标,心脑肺慢性病史、骨折后并发症也是危险因素。

Objective To investigate the risk factors of perioperative mortality in elderly patients with hip fracture.Methods Review of analysis in our hospital in 2010 07 to 2015 06 months from hip fracture and 206 cases with inclusion and exclusion criteria（ patients with femoral intertrochanteric fracture in 112 cases,94 cases of femoral neck fractures）,according to whether the occurrence of death will be divided into two groups,each index of the two groups were compared using SPSS 19. 0 the non conditional Logistic stepwise regression model analysis was carried out on the two software. Results Univariate analysis showed that cardiovascular and pulmonary disease,postoperative complications,blood albumin within24 h after admission,brain natriuretic peptide（ brain natriuretic,peptide,BNP）,blood glucose,creatinine,arterial blood p H,Pa O2,apacheii score was statistically significant difference between the two groups; Gender,age,operation mode,body temperature,respiration,heart rate,mean arterial pressure,hemoglobin,blood sodium,blood potassium,anesthesia,there was no significant difference between the two groups. Multi factor Logistic regression analysis indicated that the chronic medical history of heart and brain,postoperative complications,APACHEII,BNP scores were the risk factors of perioperative mortality in elderly patients with hip fracture. Conclusion BNP and APACHE II score as a reference index for the elderly hip fracture patients may have died,and the chronic medical history of heart and brain,the complications after fracture is also a risk factor.