老年髋部骨折患者术后短期生存风险的危险因素研究

RISK FACTORS OF SHORT-TERM SURVIVAL RISK IN ELDERLY PATIENTS WITH HIP FRACTURES

目的探讨老年髋部骨折患者术后短期生存风险的危险因素。方法回顾性分析本院2010年3月—2017年10月收治的100例老年髋部骨折患者的临床资料,所有患者均行手术治疗。根据患者术后6个月内生存情况将患者分为死亡组与存活组,对二组进行单因素比较,包括性别、年龄、骨折类型、合并内科疾病、手术方式、手术时机、麻醉方式、ASA分级、术中输血量、术后下地活动时间、出院时间、术后并发症等,采用多因素Logistic回归分析明确术后6个月内死亡的危险因素。结果100例患者中共20例在术后6个月内死亡,病死率20%。死亡组与存活组在性别、骨折类型、手术时机、麻醉方式、术中输血量、术后下地时间、住院时间、手术方式的差异无统计学意义(P>0.05);死亡组中年龄≥75岁、合并≥2种内科疾病、ASA分级Ⅲ、Ⅳ级、术后出现并发症的占比分别达70%、90%、65%、60%,显著高于存活组的43.75%、63.75%、37.50%、31.50%(P<0.05)。多因素Logistic回归分析表明年龄≥75岁、合并≥2种内科疾病、ASA分级Ⅲ、Ⅳ级为髋部骨折患者术后6个月内死亡的危险因素(P<0.05)。结论年龄≥75岁、合并≥2种内科疾病、ASA分级Ⅲ、Ⅳ级为老年髋部骨折患者术后6个月内死亡的危险因素。该类患者术前应做好管理工作,术前进行多学科综合评估,对可控因素进行积极调控,改善患者术前身体状态,以降低死亡风险。

Objective To explore the risk factors of short-term survival in elderly patients with hip fracture after operation.Methods The clinical data of one hundred elderly patients with hip fracture admitted to Second Affiliated Hospital of Xingtai Medical College from March 2010 to October 2017 were retrospectively analyzed.All patients underwent surgical treatment.The patients were divided into death group and survival group according to their survival status within 6 months after operation.The two groups were compared bysingle factor,including gender,age,fracture type,combined medical diseases,operation mode,timing of operation,anesthesia mode,ASA classification,intraoperative blood transfusion volume,time of movement after operation,time of discharge and complications after operation.Multivariate logistic regression analysis was used to clarify the difference.The risk factors of death within 6 months after operation were confirmed.Results Among the 100 patients,20 died within 6 months after operation,with a mortality rate of 20%.There was no significant difference in sex,fracture type,operation time,anesthesia mode,intraoperative blood transfusion volume,time to go to the ground after operation,hospital stay and operation mode between the death group and the survival group(P>0.05).In the death group,the proportion of patients aged≥75 years old,with≥2 medical diseases,ASA grade III,and postoperative complications were 70%,90%,65%,and 60%,respectively,significantly higher than that of the survival group(43.75%,63.75%,37.50%,31.50%)(P<0.05).Multivariate logistic regression analysis showed that the risk factors for death of hip fracture patients within 6 months after surgery were≥75 years of age,combined with≥2 medical diseases,and ASA grade III grade(P<0.05).Conclusion Age≥75 years,with≥2 medical diseases,ASA classification III,IV are risk factors for death in elderly patients with hip fracture within 6 months after surgery.In order to reduce the risk of death,it is necessary to do a good job of management before operation,to conduct a comprehensive multi-disciplinary assessment before operation,to actively regulate the controllable factors,and to improve the preoperative physical condition of the patients.