高龄患者髋部骨折手术前Nottingham评分与术后并发症关系的临床研究

Clinical study on the relationship between preoperative Nottingham score and postoperative complications in elderly patients with hip fracture

目的探讨高龄患者髋部骨折手术术前Nottingham评分与术后并发症之间的关系,并预见性地针对并发症给予治疗。方法随机选取2018年9月至2019年10月蚌埠市第三人民医院接诊的高龄髋部骨折患者130例作为研究对象,对其诊疗资料进行回顾性分析。依据Nottingham评分将患者分为低Nottingham评分组(≤4分)和高Nottingham评分组(>4分),每组65例。对患者的年龄、性别、体重、身高、术前诊断、ASA分级、麻醉和手术方式、失血量、尿量、术中输血情况、使用血管活性药物以及术后并发症等指标进行评价,对比分析术前Nottingham评分与高龄患者髋部骨折术并发症之间的关系。结果①低Nottingham评分组和高Nottingham评分组患者在体重、身高和术中出血量方面差异无统计学意义(P>0.05);②高Nottingham评分组患者的ASAⅢ级患者所占比率明显高于低Nottingham评分组,差异有统计学意义(P<0.05);③2组患者的术前诊断类型以及手术类型差异无统计学意义(P>0.05);④高Nottingham评分组患者中采取腰硬联合麻醉(CSEA)/外周神经阻滞(PNB)的麻醉方式、术中使用血管活性药物以及入院前需要他人看护所占比率明显要高于低Nottingham评分组,差异均有统计学意义(P<0.05);⑤高Nottingham评分组患者的输血比率高于低Nottingham评分组,尿量低于低Nottingham评分组,差异均有统计学意义(P<0.05);2组48 h内手术比率和失血量比较,差异无统计学意义(P>0.05);⑥2组患者的术前住院时间比较,差异无统计学意义(P>0.05);高Nottingham评分组患者的术后住院时间和总住院时间明显短于低Nottingham评分组,差异有统计学意义(P<0.05);⑦高Nottingham评分组患者术后肾功能不全、术后肺部感染、术后心肌梗死或者心力衰竭、术后心律失常、术后下肢深静脉血栓形成(DVT)、术后急性脑梗死、术后电解质紊乱、术后低氧血症、术后谵妄以及ICU留观发生比率明显高于低Nottingham评分组,差异均有统计学意义(P<0.05);⑧高Nottingham评分组患者术后血红蛋白≤100 g/L、术后高血压、术后低血压以及住院期间死亡者比率与低Nottingham评分组相比,差异无统计学意义(P>0.05)。结论高龄患者髋部骨折手术术前Nottingham评分可有效评估术后并发症的发生情况,其中术前Nottingham评分>4分的患者出现并发症的可能性较大,因此对于此类患者要给予高度重视,以降低术后并发症发生率。

Objective To explore the relationship between preoperative Nottingham score and postoperative complications in elderly patients with hip fracture.Methods A total of 130 elderly patients with hip fracture treated in the Third People's Hospital of Bengbu from September 2018 to October 2019 were randomly selected as the object of this study,and the diagnosis and treatment data were analyzed retrospectively.According to Nottingham score,the patients were divided into low Nottingham score group(≤4)and high Nottingham score group(>4),with 65 cases in each group.The age,sex,body mass,height,preoperative diagnosis,ASA grade,mode of anesthesia and operation,blood loss,urine volume,intraoperative blood transfusion,use of vasoactive drugs and postoperative complications were evaluated,and the relationship between preoperative Nottingham score and complications of hip fracture in elderly patients was compared and analyzed.Results①There was no significant difference in body mass,height and intraoperative blood loss between low Nottingham score group and high Nottingham score group(P>0.05).②The percentage of ASA gradeⅢpatients in high Nottingham score group was significantly higher than that in low Nottingham score group,the difference was statistically significant(P<0.05).③There was no significant difference in preoperative diagnosis type and operation type between the two groups(P>0.05).④The percentage of CSEA/PNB anesthesia,the use of vasoactive drugs during operation and the need for care before admission in patients with high Nottingham score were significantly higher than those in low Nottingham score group,the differences were statistically significant(P<0.05).⑤The blood transfusion rate of patients in high Nottingham score group was higher than that in low Nottingham score group,but the urine volume was lower than that in low Nottingham score group,the differences were statistically significant(P<0.05).There was no significant difference in operation rate and blood loss within 48 hours between the two groups(P>0.05).⑥There was no significant difference in preoperative hospital stay between the two groups(P>0.05),but the postoperative hospital stay and total hospital stay of patients with high Nottingham score were significantly shorter than those with low Nottingham score group,the differences were statistically significant(P<0.05).⑦The rates of postoperative renal insufficiency,postoperative pulmonary infection,postoperative myocardial infarction or heart failure,postoperative arrhythmia,postoperative DVT,postoperative acute cerebral infarction,postoperative electrolyte disturbance,postoperative hypoxemia,postoperative delirium and ICU retention in patients with high Nottingham score were significantly higher than those in low Nottingham score group,the differences were statistically significant(P<0.05).⑧There was no significant difference in postoperative hemoglobin≤100 g/L,postoperative hypertension,postoperative hypotension and in-hospital death rate between patients with high Nottingham score group and those with low Nottingham score group(P>0.05).Conclusion The preoperative Nottingham score of the elderly patients with hip fracture can effectively evaluate the occurrence of postoperative complications,among which the patients with preoperative Nottingham score>4 are more likely to develop complications,so we should pay more attention to this kind of patients in order to reduce the incidence of postoperative complications.