高龄患者髋关节置换围手术期发生脑梗死危险因素的相关研究

Risk factors of cerebral infarction during perioperative period in elderly patients with hip arthroplasty

背景:目前,高龄患者接受人工髋关节置换围手术期发生脑梗死的相关危险因素尚不明确。目的:分析高龄患者髋关节置换术围手术期发生脑梗死的独立危险因素。方法:选取2008年12月至2018年2月在河北省唐山市第二医院接受髋关节置换的围手术期患者为研究对象。采用1:2比例的病例对照研究方法,对临床资料分别进行单因素分析和多因素Logistic回归分析。结果:收集符合入选标准的病例组68例,对照组136例。病例组:男36例,女32例,年龄61～83岁,平均(70.4±11.0)岁;对照组:男76例,女60例,年龄60～85岁,平均(72.3±10.6)岁。单因素分析:两组在高血压病、房颤、既往卒中史或短暂性脑缺血发作(TIA)病史、术中低血压、术后感染上差异有统计学意义(P<0.05),而年龄、性别、糖尿病、白细胞计数、全身麻醉、手术持续时间、术后血容量不足比较,差异无统计学意义(P>0.05)。多因素Logistic分析:调整了年龄、性别因素后,术中低血压(OR=3.303,95%CI:1.548～7.047,P=0.002)、高血压病(OR=2.409,95%CI:1.143～5.079, P=0.021)与高龄患者髋关节置换术围手术期脑梗死的发生有关。结论:高血压病史和术中低血压是高龄患者髋关节置换术围手术期发生脑梗死的独立危险因素,对于行髋关节置换术的高龄患者术中发生低血压与围手术期脑梗死的发生关系最为密切。

Background： Related risk factors of cerebral infarction during perioperative period of hip arthroplasty are not clear in China. Objective： To explore independent risk factors of cerebral infarction during perioperative period of hip arthroplasty in elderly patients. Methods： Senior patients sceduled for hip arthroplasty in Tangshan Second Hospital of Hebei province from December 2008 to February 2018 were selected for research objects. Single factor analysis and multi-factor Logistic regression analysis were used to analyze clinical parameters in this case-control study with a ratio of 1 to 2. Results： According to inclusion criteria,68 patients（36 males and 32 females with a mean age of [70.4± 11.0] years,range 61-83 years） were enrolled in case group and 136 patients（76 males and 60 females with a mean age of [72.3±10.6] years, range 60-85 years） in control group. Single factor analysis showed that there were significant differences between two groups in hypertension, atrial fibrillation, history of stroke or transient ischemic attack（TIA）, intraoperative hypotension and postoperative infection（P〈0.05）, but no significant difference was found in age, sex, diabetes mellitus, WBC count, general anesthesia, operation time or postoperative blood volume insufficiency（P〈0.05）. After adjustment of age and sex, intraoperative hypotension（OR=3.303,95%CI： 1.548-7.047, P=0.002） and hypertension（OR=2.409, 95%CI： 1.143-5.079, P=0.021） were related to the occurrence of perioperative cerebral infarction in elderly patients undergoing with hip arthroplasty. Conclusions： Preoperative hypertension and intraoperative hypotension are independent risk factors of cerebral infarction during perioperative period of hip arthroplasty in elderly patients, especially the intraoperative hypotension.