手术治疗髋部骨折合并慢性阻塞性肺疾病患者的短期和长期预后影响因素

Short-term and long-term prognostic factors in surgically treated hip fracture patients with chronic obstructive pulmonary disease

目的探索和分析手术治疗髋部骨折合并慢性阻塞性肺疾病(COPD)患者的短期和长期预后影响。方法回顾性分析2015年1月至2017年1月内蒙古科技大学包头医学院第一附属医院348例髋部骨折患者的临床资料,按照是否合并COPD将患者分为合并COPD组(136例)和对照组(212例)。统计患者术后功能恢复时间、存活情况,采用单因素分析及多因素logistic回归分析探讨影响COPD患者术后1、5年死亡的因素。结果合并COPD组患者的功能恢复时间长于对照组。合并COPD组患者的术后1年死亡率为22.06%,术后5年死亡率为48.53%,均高于对照组,差异有统计学意义(P<0.05)。术后1年死亡组共30例患者,存活组共106例患者。单因素分析显示,两组患者的性别、急性加重期慢性阻塞性肺疾病(AECOPD)发生情况、美国麻醉师协会(ASA)分级、合并内科疾病、伤前日常生活能力(ADL)评分、手术延迟情况比较,差异有统计学意义(P<0.05);两组患者的性别骨折部位比较,差异无统计学意义(P>0.05)。以合并COPD组患者术后1年预后为因变量,以单因素分析中差异有统计学意义的因素为自变量,采用logistic回归模型进行多因素分析,结果显示,男性、AECOPD、ASA分级为Ⅲ+Ⅳ级、有独立行走行动能力、伤前ADL评分<60分、延迟手术治疗是髋部骨折合并COPD患者术后1年死亡的独立危险因素(P<0.05)。术后5年死亡组共66例患者,存活组共70例患者。单因素分析显示,性别、不同的骨折部位、AECOPD发生情况、ASA分级、伤前ADL评分、手术延迟情况,行动能力情况等比较,差异有统计学意义(P<0.05);两组患者的合并内科疾病比较,差异无统计学意义(P>0.05)。AECOPD、ASA分级为Ⅲ+Ⅳ级、伤前ADL评分<60分是髋部骨折合并COPD患者术后5年死亡的独立危险因素(OR>1,P<0.05)。结论髋部骨折合并COPD术后短期及长期预后情况较差,其中AECOPD、ASA分级为Ⅲ+Ⅳ级、伤前ADL评分<60分是影响患者短期和长期预后的独立危险因素。

Objective To explore and analyze the short-term and long-term prognostic impact of surgical treatment of hip fractures in patients with chronic obstructive pulmonary disease(COPD).Methods The clinical data of 348 patients with hip fracture in the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from January 2015 to January 2017 were retrospectively analyzed,and the patients were divided into combined COPD group(136 cases)and control group(212 cases)according to whether they were combined with COPD or not.The postoperative functional recovery time and survival of the patients were counted,and explore the factors affected postoperative mortality in COPD patients at 1 and 5 year using univariate analysis and multivariate logistic regression analysis.Results The functional recovery time of patients in the combined COPD group was longer than that of the control group.The 1 year postoperative mortality rate of patients with combined COPD was 22.06%,and the 5 year postoperative mortality rate was 48.53%,both of which were higher than those of the control group,with statistically significant differences(P<0.05).There were 30 patients in the death group and 106 patients in the survival group one year after surgery.Univariate analysis showed that there were statistically significant differences in gender,acute exacerbation of chronic obstructive pulmonary disease(AECOPD)occurrence situation,American Society of Anesthesiologists(ASA)grading,comorbidities with internal medicine,pre-injury ability of daily living(ADL)grading and surgical delay between the two groups(P<0.05).There were no statistically significant differences between the two groups in terms of gender and fracture site(P>0.05).Using the 1 year postoperative prognosis of patients with combined COPD as the dependent variable and statistically significant factors in univariate analysis as the independent variables,a logistic regression model was used for multivariate analysis.The results showed that male,AECOPD,ASA gradeⅢ+Ⅳ,independent walking ability,pre-injury ADL score<60 points,and delayed surgical treatment were independent risk factors for 1 year mortality in patients with hip fracture combined COPD(P<0.05).There were a total of 66 patients in the death group and 70 patients in the survival group 5 years after surgery.Univariate analysis showed that there were statistically significant differences in gender,different fracture sites,AECOPD occurrence situation,ASA grade,pre-injury ADL score,surgical delay,and mobility(P<0.05).There was no statistically significant difference in the comorbidities of internal medicine between the two groups of patients(P>0.05).AECOPD,ASA gradeⅢ+Ⅳ,and pre-injury ADL score<60 were independent risk factors for 5 year postoperative death in patients with hip fracture complicated with COPD(OR>1,P<0.05).Conclusion The short-term and long-term prognosis of hip fracture combined with COPD are poor,among which AECOPD,ASA gradeⅢ+Ⅳ,and pre-injury ADL score<60 are independent risk factors that affect the short-term and long-term prognosis of patients.