探讨258例老年髋部骨折患者术前发生下肢深静脉血栓的危险因素及麻醉特点

Factors associated with lower extremity deep venous thrombosis in elderly patients with hip fracture before surgery and their anesthetic characteristics:An analysis of 258 cases

背景髋部骨折是老年患者致残、致死的主要原因之一。骨折后若发生下肢深静脉血栓可明显增加老年髋部骨折患者的住院时间和死亡率。目的探讨70岁以上老年髋部骨折患者术前发生下肢深静脉血栓的危险因素及麻醉特点。方法回顾性分析解放军总医院海南医院麻醉科2012年1月-2018年12月收治的258例70岁以上髋部骨折患者的临床资料。根据术前下肢静脉超声是否发生深静脉血栓分为深静脉血栓组和非深静脉血栓组。多因素分析术前发生深静脉血栓的危险因素,以及该类患者并存疾病和麻醉特点。结果本组15例(5.8%)患者术前发生深静脉血栓,其中3例放置下腔静脉滤器。152例(58.9%)患者术前ASA评级为Ⅲ~Ⅳ级;135例(52.3%)患者采取神经阻滞麻醉,48例(18.6%)患者采取全身麻醉;17例(6.6%)患者骨折后48 h内手术。深静脉血栓组与非深静脉血栓组术前贫血[12例(80.0%)vs 116例(48.5%)]、骨折到手术时间[14.0(7.3,31.8)d vs 9.0(6.0,11.0)d]差异均有统计学意义(P均<0.05);多因素logistic分析示术前贫血(OR:0.296;95%CI:0.075-1.170;P=0.083)和骨折到手术时间(OR:1.020;95%CI:0.997-1.044;P=0.094)不是术前发生深静脉血栓的独立危险因素。结论本研究尚未发现术前贫血和骨折到手术时间是高龄髋部骨折患者术前发生下肢深静脉血栓的独立危险因素。这类患者术前ASA评级高,基础疾病多,神经阻滞麻醉为其主要麻醉方式。

Background Hip fracture is one of the main causes of disability in elderly patients. Deep vein thrombosis of the lower extremity following a fracture can significantly increase the length of hospital stay and mortality. Objective To analyze the risk factors of preoperative deep venous thrombosis(DVT) in elderly hip fracture patients over 70 years old, as well as the characteristics of coexisting diseases and anesthesia. Methods From January 2012 to December 2018, clinical data about 258 hip fracture patients over 70 years old admitted to department of anesthesiology, Hainan Hospital of Chinese PLA General Hospital were retrospectively collected and analyzed. The patients were divided into DVT group and non DVT group(NDVT group) according to whether they had DVT before operation. The risk factors of DVT before operation were analyzed by multivariate analysis, and the characteristics of coexisting diseases and anesthesia were statistically analyzed. Results Of the 258 cases, 15 patients(5.8%) had DVT before operation, and 3 of them had inferior vena cava filter before operation. Among the two groups, 152(58.9%) patients had preoperative ASA grade Ⅲ-Ⅳ, 135(52.3%) patients received nerve block anesthesia, and 48(18.6%) patients received general anesthesia. Seventeen patients(6.6%) underwent surgery within 48 hours after fracture. Univariate analysis showed that there were statistically significant differences in anemia [12(80.0%) vs 116(48.5%)], fracture to operation [14.0(7.3, 31.8) d vs 9.0(6.0, 11.0) d]between the DVT group and the NDVT group(all P < 0.05). Anemia(OR: 0.296;95% CI: 0.075-1.170;P=0.083) and fracture to operation time(OR: 1.020;95% CI: 0.997-1.044;P=0.094) was not independently associated with the occurrence of preoperative deep vein thrombosis. Conclusion This study has not found that preoperative anemia and the time from fracture to operation are independent risk factors for preoperative lower extremity DVT in elderly patients with hip fracture. Nerve block anesthesia is the main anesthesia characteristics for patients with high preoperative ASA and basic disease.