老年髋部骨折患者术后1年脑卒中发生危险因素及预后分析

Risk factors and prognosis of acute stroke within 1 year after hip fracture surgery in elderly patients

目的探讨老年髋部骨折患者术后1年内发生急性脑卒中的危险因素及对预后的影响。方法回顾性分析2018年1月至2020年12月我院收治老年髋部骨折患者278例,男101例,女177例,年龄60~99岁,平均(78.9±8.7)岁;根据患者术后1年内是否发生急性脑卒中,分为脑卒中组和非脑卒中组,通过多因素Logistic回归分析老年髋部骨折患者术后1年内急性脑卒中的危险因素,并分析预后。结果术后1年内共28例(10.1%)发生脑卒中,术后3个月是脑卒中发生高峰,脑卒中组患者年龄大,伤前合并高血压、心律失常、脑卒中病史、使用抗凝或抗血小板药物比率高(均P<0.05);多因素Logistic回归分析提示高龄(OR=1.078,95%CI=1.007~1.153,P=0.030)、男性(OR=2.643,95%CI=1.060~6.742,P=0.037)、既往脑卒中病史(OR=12.202,95%CI=4.662~31.940,P<0.001)是老年髋部骨折患者术后1年发生脑卒中的独立危险因素;脑卒中组患者术后1年病死率、并发症发生率和再入院率(均P<0.05)显著高于无脑卒中组。结论老年髋部骨折患者术后1年脑卒中发生率高,高龄、男性、脑卒中病史是术后1年急性脑卒中发生的独立危险因素,脑卒中患者预后差,术后1年病死率、并发症发生率和再入院率高。

Objective To study the risk factors of acute stroke within l year after hip fracture in the elderly and its effect on prognosis.NMethods From January 2018 to December 2020,278 elderly hip fracture patients undergoing surgery were retrospectively analyzed,including 101 males and 177 females,aged from 60 to 99 years with an average of(78.9±8.7)years.According to whether acute stroke occurred within 1 year after operation,the patients were divided into stroke group and nonstroke group.A multivariate Logistic regression was used to evaluate the risk factors for acute stroke within 1 year after hip fracture,and the prognosis was analyzed.Results Acute stroke occurred in 28 patients(10.1%)within 1 year after operation,and the peak of stroke onset occurred in the third months after operation.Patients in the stroke group were older,and had a higher proportion of hypertension,arrhythmia,previous stroke history,and use of anticoagulant or antiplatelet drugs before fracture(P<0.05 for all).Multivariate Logistic regression analysis showed that advanced age(OR=1.078,95%CI=1.007-1.153,P=0.030),male(OR=2.643,95%CI=1.060-6.742,P=0.037)and previous stroke history(OR=12.202,95%CI=4.662-31.940,P<0.001)were independent risk factors for stroke in elderly patients with hip fracture within 1 year after operation.The l-year mortality,complication rate and readmission rate in the stroke group were significantly higher than those in the non-stroke group(P<0.05 for all).Conclusions The incidence of stroke is high in elderly patients with hip fracture within 1 year after operation.Older age,male,and previous stroke history were independent risk factors for acute stroke.The prognosis of stroke was poor in elderly patients with hip fracture,and the 1-year mortality,complication and readmission rates were high.