痴呆对老年髋部骨折预后影响及老年髋部骨折预后危险因素分析

Effects of Dementia on Prognosis for and Prognostic Risk Factors of Hip Fracture in the Elderly

目的探讨痴呆对老年髋部骨折预后影响及老年髋部骨折预后危险因素。方法选取老年髋部骨折521例作为研究对象,根据术前认知功能状态将其分为痴呆组和非痴呆组两组,痴呆组49例,非痴呆组472例;根据术后1年随访结局将其分为病死组和存活组,病死组103例,存活组418例。分析比较患者一般数据、术中情况、住院期间并发症、术后1年病死率及独立生活能力等,并对老年髋部骨折术后1年内死亡的危险因素进行分析。结果本研究老年髋部骨折合并痴呆患者占老年髋部骨折患者的9. 4%。与非痴呆组比较,痴呆组≥80岁、其他神经系统合并症、全身麻醉、呼吸系统并发症、脑卒中及谵妄发生率较高,住院时间较长,围手术期及术后1年病死率较高,差异有统计学意义(P <0. 05)。单因素分析结果显示,年龄≥80岁、男性、痴呆、心血管系统合并症、呼吸系统合并症、合并症≥3项及美国麻醉协会麻醉(ASA)分级Ⅲ~Ⅳ级是老年髋部骨折术后1年内死亡的危险因素。多因素Logistic回归分析显示仅有呼吸系统合并症、合并症≥3项及ASA分级Ⅲ~Ⅳ级是老年髋部骨折术后1年内死亡的独立危险因素。结论痴呆在老年髋部骨折人群中发病率较高。与非痴呆老年髋部骨折患者相比,老年髋部骨折合并痴呆患者住院时间长、术后并发症多,且病死率高。呼吸系统合并症、合并症≥3项及ASA分级Ⅲ~Ⅳ级是老年髋部骨折术后1年内死亡的独立危险因素。

Objective To investigate the effect of dementia on the prognosis of and prognostic risk factors for hip fracture in the elderly. Methods A total of 521 elderly patients with hip fractures were selected as the study subjects. According to the preoperative cognitive function, they were divided into two groups： dementia group （ n =49） and non-dementia group（ n =472）.They were then divided into death group （ n =103） and survival group（418） based on the results of one-year follow-up after surgery. The general information, intraoperative conditions, complications during hospitalization, postoperative mortality and independent living ability as well as the independent risk factors of mortality of the elderly with hip fracture at 1 year after operation were analyzed. Results In this study, elderly patients with hip fracture and dementia accounted for 9.40% of those with hip fracture. Compared with non-dementia group, patients in dementia group were 80 years old or older, and there was a higher incidence of nervous system comorbidities, general anesthesia, respiratory complications, stroke and convulsions. In addition, the length of hospital stay was longer, and the perioperative and postoperative 1-year mortality rates were higher, suggesting significant differences （ P 〈0.05）. Univariate analysis showed that age ≥ 80 years, male, dementia, cardiovascular comorbidities, respiratory comorbidities, number of comorbidities ≥ 3, and ASA grade III-IV were risk factors for mortality of elderly patients with hip fracture at 1 year after operation. Multivariate logistic regression analysis showed that respiratory comorbidities, American Society of Anesthesiologists （ASA） grade III-IV and number of comorbidities ≥3 were independent risk factors for mortality of the elderly with hip fracture at 1 year after operation. Conclusion The incidences of dementia in the elderly with hip fracture were high, and were more prone to be associated with longer hospital stays, more postoperative complications and higher mortality than those with hip fracture and without dementia. Respiratory comorbidities, ASA grade III to IV, and number of comorbidities ≥ 3 and ASA grade III-IV are independent risk factors for mortality of the elderly with hip fracture within 1 year after operation.