老年髋部骨折术后谵妄与术后6个月死亡率及危险因素分析

Postoperative prognosis, 6-month mortality rate, and risk factors for hip fractures in the elderly

目的探讨老年髋部骨折患者术后6个月死亡风险因素及老年髋部骨折患者术后谵妄和术后6个月死亡率的关系。方法分析2019年7月至2021年5月在郑州大学第一附属医院因髋部骨折接受手术治疗的688例老年患者临床资料。根据患者术后6个月的生存情况, 分为存活组与死亡组, 单因素分析各组在性别、年龄、体重指数(BMI)、骨折类型、美国麻醉医师协会(ASA)分级、手术方式、术中出血量、中性粒细胞/淋巴细胞比值(NLR)、术后谵妄情况, 并采用多因素Logistic回归分析得到老年部骨折术后6月死亡的独立危险因素。结果 73例患者术后6个月内死亡, 死亡率为10.61%。单因素分析结果显示, 存活组与死亡组在性别(χ2=11.346, P<0.01)、年龄(Z=-3.713, P<0.01)、ASA分级Ⅲ或Ⅳ级(χ2=16.858, P<0.01), NLR(Z=-3.150, P<0.05), 术后谵妄(Z=8.352, P<0.05)和血红蛋白(χ2=-3.443, P<0.01)差异均有统计学意义。Logistic多因素分析结果显示, 性别[比值比(OR)=2.597, P<0.01], 年龄(OR=1.036, P<0.05), ASA Ⅳ或Ⅴ级(OR=2.401, P<0.01), NLR(OR=1.042, P<0.05), 术后谵妄(OR=1.731, P<0.05)以及术前血红蛋白浓度(OR=0.981, P<0.01)是老年部骨折术后6个月死亡的独立危险因素。结论年龄、性别、ASA分级、NLR、术后谵妄、术前血红蛋白浓度是老年部骨折术后6个月死亡的独立危险因素, 术后谵妄与老年髋部骨折术后6个月生存明显相关。

Objective To investigate the risk factors for mortality within 6 months after surgery in elderly patients with hip fractures,as well as to examine the relationship between postoperative delirium and the mortality rate at 6th month in these patients.Methods The clinical data of 688 elderly patients who underwent surgical treatment for hip fractures at the First Affiliated Hospital of Zhengzhou University from July 2019 to May 2021 were analyzed.The patients were divided into survivor group and death group based on their survival status at 6th month after surgery.Univariate analysis was performed to analyze the differences between the groups in terms of gender,age,body mass index(BMI),fracture type,American Society of Anesthesiologists(ASA)classification,surgical procedures,intraoperative blood loss,neutrophil-to-lymphocyte ratio(NLR),and postoperative delirium multivariate logistic regression analysis was used to identify independent risk factors for 6-month mortality in elderly patients with hip fractures.Results There were 73 deaths within 6 months after surgery,with a mortality rate of 10.61%.The results of univariate analysis showed that there were statistically significant differences between the survivor group and the death group in terms of gender(χ2=11.346,P<0.01),age(Z=-3.713,P<0.01),ASA gradeⅢorⅣ(χ2=16.858,P<0.01),NLR(Z=-3.150,P<0.05),postoperative delirium(Z=8.352,P<0.05),and hemoglobin(χ2=-3.443,P<0.01).The results of logistic multivariate analysis showed that gender[odds ratio(OR)=2.597,P<0.01],age(OR=1.036,P<0.05),ASA gradeⅣorⅤ(OR=2.401,P<0.01),NLR(OR=1.042,P<0.05),postoperative delirium(OR=1.731,P<0.05),and preoperative hemoglobin concentration(OR=0.981,P<0.01)were independent risk factors for mortality within 6 months after surgery for elderly patients with femoral neck fractures.Conclusion Age,gender,ASA grade,NLR,postoperative delirium,and preoperative hemoglobin concentration are independent risk factors for mortality within 6 months after surgery for elderly patients with femoral neck fractures.Postoperative delirium is closely associated with survival within 6 months after surgery for elderly hip fractures.