绿色通道建设提高高龄髋部骨折患者治疗的有效性与安全性

Green channel channel improving efficacy and safety of the treatment of elderly patients with hip fractures

目的观察绿色通道建设在高龄髋部骨折患者治疗中的应用效果,为高龄髋部骨折患者的规范化治疗提供依据。方法回顾性分析2014年6月—2015年6月经治的115例高龄(≥75岁)髋部骨折患者的临床资料,根据诊治流程不同分为绿色通道组(58例)和常规处理组(57例)。比较两组患者的手术等待时间、手术时间、出血量、住院时间及住院期间的术后全身并发症和局部并发症发生情况。结果绿色通道组手术等待时间(中位数43.6h)明显短于常规处理组(中位数136.8h),差异具有统计学意义(P<0.01);绿色通道组住院时间[(4.3±1.2)d]明显短于常规处理组[(8.5±2.5)d],差异具有统计学意义(P<0.05);两组手术时间、出血量差异无统计学意义(P>0.05)。绿色通道组11例(19.0%)发生并发症,常规处理组29例(50.9%)发生并发症,常规处理组并发症发生率高于绿色通道组(P<0.01);绿色通道组肺部感染和压疮的发生率明显低于常规处理组[3.4%(2/58)vs 14.0%(8/57),P<0.05;3.4%(2/58)vs 15.8%(9/57),P<0.05],两组患者肺栓塞、脑梗死、深静脉血栓、心肌梗死、切口感染发生率差异无统计学意义。结论绿色通道建设应用于高龄髋部骨折的治疗,在条件允许的情况下早期手术有利于缩短高龄髋部骨折患者的住院时间、减少术后并发症,促进髋部功能的康复,对老年髋部骨折的规范化治疗具有重要和积极的意义。

Objective To observe the application of the Green channel in the treatment of elderly patients with hip fracture, so as to provide a reference for the standardized treatment. Methods We retrospectively analyzed the clinical data of 115 elderly patients （975 years） with hip fractures treated in hospital from Jun. 2014 to Jun. 2015. The patients were treated through the Green channel （Green channel group, n = 58） or received conventional treatment （normal group, n = 57）. The waiting time for operation, operation time, bleeding volume, hospital stay, and postoperative systemic and local complications during hospitalization were compared between the two groups. Results The waiting time for operation of patients in the Green channel group （median 43. 6 h） was significantly shorter than that in the normal group （median 136.8 h, P〈0. 01）, and the hospital stay of patients in the Green channel group （[4. 3±1.2] d） was significantly shorter than that in the normal group （[8. 5±2. 5] d, P〈0. 05）. There was no significant difference in the operation time or bleeding volume between the two groups （P〉0. 05）. The incidence of complications of patients in the Green channel group （11/58, 19.0%） was significantly higher than that in the normal group （29/57, 50. 9%; P〈0. 01）. The incidences of pulmonary infection and pressure sores of patients in the Green channel group were significantly lower than those in the normal group （3. 4% [2/58] vs 14. 0% [-8/57], P〈0. 05; 3. 4% [2/58] vs 15. 8% [9/57], P〈 0. 05）. There was no significant difference in the incidences of pulmonary embolism, cerebral infarction, deep vein thrombosis, myocardial infarction, or incision infection between the two groups. Conclusion Application of the Green channel in the treatment of elderly patients with hip fracture can allow early surgery under suitable conditions, which is conducive to reduce hospital stay and postoperative complications and can promote the recovery of hip function, indicating that the Green channel has an important significance for standardized treatment of eldery patients with hip fractures.