老年患者关节置换术中发生严重骨水泥植入综合征高危因素回顾性分析

Retrospective analysis of high risk factors of severe bone cement implantation syndrome in elderly patients underwent arthroplasty

目的为了更有效地降低人工关节置换术中老年人发生严重骨水泥植入综合征(Bone cement implantation syndrome,BCIS),综合分析了其临床表现、致死机制及预防措施。方法对2000年1月—2018年12月发表的"发生严重BCIS"的36篇文章,共计62例患者进行回顾性分析。结果女性、高龄、人工髋关节置换术是发生严重BCIS,导致围术期死亡的高危因素。严重的BICS基本发生在骨水泥填充后即刻至数分钟内,而且手术创伤越大、部位越近心端,严重BICS的发生率越高,预后越差。糖皮质激素类药物防治关节置换术中严重BCIS的发生和降低其引起死亡率的效果并不确切。结论女性、高龄、人工髋关节置换术是发生严重BCIS,导致围术期死亡的高危因素。术前要积极做好预防工作,最大限度地降低严重BCIS的发生率和其不良影响。

Objective To minimize more effectively severe bone cement implantation syndrome( BCIS) in elderly patients underwent arthroplasty,we comprehensively analyzed its clinical manifestations,lethal mechanism and preventive measures. Methods A retrospective analysis of 36 articles published from January 2000 to December 2018 about severe BCIS occurred in 62 patients. Results Female,elderly and hip replacement are the high risk factors for severe BCIS causing perioperative death. The severe BCIS could occur within minutes after filling the cement. Moreover,with the greater the surgical trauma and the closer the site to the heart end,severe BCIS was the higher incidence and its prognosis was much worse.The effects of glucocorticoids were not accurate in preventing and treating the severe BCIS in elderly patients with arthroplasty and reducing its mortality. Conclusion Female,elderly and hip replacement were high risk factors for severe BCIS to result in perioperative death. The prevention work should be done before operation so as to minimize the incidence of severe BCIS and its adverse effects.