老年股骨转子间骨折患者围手术期发生心力衰竭的相关因素分析

Risk factors for perioperative heart failure in elderly patients with femoral intertrochanteric fracture

目的 探讨老年股骨转子间骨折患者围手术期发生心力衰竭的相关危险因素,以期指导其围手术期心力衰竭的预防.方法 回顾性分析2013年5月至2016年8月期间采用闭合复位髓内钉固定治疗的175例老年股骨转子间骨折患者资料.根据围手术期是否发生心力衰竭分为两组：心衰组31例,男12例,女19例;年龄为（73.5 ±7.8）岁;无心衰组144例,男61例,女83例;年龄为（69.8±6.9）岁.比较两组患者的年龄,是否早期手术,有无原发性高血压病史、呼吸道病史、心脏病病史、意识障碍,术前肾功能情况,手术时间,麻醉方式,围手术期液体出入量差值,围手术期疼痛视觉模拟（VAS）评分,以及术后血红蛋白等资料.对差异有统计学意义的资料再进行多因素logistic回归分析,以明确独立的危险因素. 结果 两组患者的年龄、有无心脏病病史、围手术期液体出入量差值及围手术期疼痛VAS评分比较差异均有统计学意义（P＜0.05）.多因素logistic回归分析结果显示：老年股骨转子间骨折围手术期发生心力衰竭的危险因素为年龄[P =0.014,OR=1.063（1.012,1.116）]、心脏病病史[P=0.008,OR=4.977（1.526,16.230）]、围手术期液体出入量差值[P=0.025,OR =2.421 （1.117,5.249）]、围手术期疼痛VAS评分[P=0.040,OR=2.292（1.040,5.050）]. 结论 老年股骨转子间骨折患者围手术期发生心力衰竭的危险因素包括年龄、心脏病病史、围手术期液体出入量差值、围手术期疼痛VAS评分.对患者的这些因素应详细记录并充分评估,及时实施有效的围手术期预防处理措施,避免围手术期发生心力衰竭.

Objective To study the risk factors for perioperative heart failure in the elderly patients with femoral intertrochanteric fracture so as to provide guide information for prevention of the perioperative heart failure.Methods Included in this retrospective study were 175 elderly patients with femoral intertrochanteric fracture who had undergone closed reduction and intramedullary nail fixation in our hospital from May 2013 to August 2016.They were divided into 2 groups.In the heart failure group of 31 cases,there were 12 males and 19 females,with an age of 73.5 ± 7.8 years;in the non heart failure group of 144 cases,there were 61 males and 83 females,with an age of 69.8 ± 6.9 years.The 2 groups were compared in terms of age,early surgery,hypertension history,respiratory disease history,heart disease history,disturbance of consciousness,preoperative renal function,operation time,anesthesia method,operation time,perioperative fluid volume difference,perioperative pain score,and postoperative hemoglobin.After univariate analysis of these factors,the risk factors were determined through the multivariate regression analysis.Results The univariate analysis showed that age,heart disease history,perioperative fluid volume difference and perioperative pain score were statistically different between the 2 groups （P ＜ 0.05）.By the multivariate analysis,the risk factors for perioperative heart failure were age [P =0.014,OR =1.063 （1.012,1.116）],heart disease history [P =0.008,OR =4.977 （1.526,16.230）],perioperative fluid volume difference [P =0.025,OR=2.421 （1.117,5.249）],and perioperativepain score [P=0.040,OR=2.292（1.040,5.050）].Conclusions Age,heart disease history,perioperative fluid volume difference and perioperative pain score may be the risk factors for perioperative heart failure in elderly patients with femoral intertrochanteric fracture.We should pay attention to these factors and evaluate their influences on the patient so as to take appropriate perioperative prevention and treatment measures to reduce the incidence of perioperative heart failure.