老年股骨干合并同侧股骨颈骨折术后应激性溃疡的发生情况及危险因素

Incidence and Risk Factors of Stress Ulcer in Elderly Patients with Femoral Shaft with Ipsilateral Femoral Neck Fractures

目的分析老年股骨干合并同侧股骨颈骨折术后应激性溃疡的发生情况及危险因素。方法回顾性分析2012年12月至2022年12月空军军医大学第二附属医院收治的128例老年股骨干合并同侧股骨颈骨折患者的临床资料,统计老年股骨干合并同侧股骨颈骨折患者术后应激性溃疡的发生情况,采用单因素及多因素Logistic回归分析老年股骨干合并同侧股骨颈骨折术后应激性溃疡发生的危险因素。结果128例老年股骨干合并同侧股骨颈骨折患者术后2周内,共31例(24.22%)患者发生应激性溃疡。应激性溃疡组患者年龄、长期服用非甾体抗炎药、存在消化性溃疡史、骨折原因为交通事故、手术麻醉时间≥2 h及机械通气时间≥48 h者占比均明显高于非应激性溃疡组[(81±6)岁比(79±6)岁、54.84%(17/31)比22.68%(22/97)、54.84%(17/31)比13.40%(13/97)、80.65%(25/31)比57.73%(56/97)、61.29%(19/31)比34.02%(33/97)、41.94%(13/31)比14.43%(14/97)](P<0.05或P<0.01)。多因素Logistic回归分析显示,高龄、长期服用非甾体抗炎药、存在消化性溃疡史、骨折原因为交通事故、手术麻醉时间≥2 h、机械通气时间≥48 h是老年股骨干合并同侧股骨颈骨折患者术后应激性溃疡发生的危险因素(OR=2.250,95%CI 1.694~2.806;OR=3.053,95%CI 2.468~3.637;OR=3.277,95%CI 2.509~4.045;OR=2.354,95%CI 1.715~2.992;OR=2.474,95%CI 1.812~3.137;OR=2.782,95%CI 2.064~3.499)(均P<0.01)。结论老年股骨干合并同侧股骨颈骨折患者术后发生应激性溃疡的危险因素较多,临床治疗中针对年龄较大、长期服用非甾体抗炎药、存在消化性溃疡史、骨折原因为交通事故、手术麻醉时间≥2 h及机械通气时间≥48 h等高危人群需给予重视,密切关注其病情变化,并及时给予干预措施。

Objective To analyze the incidence and risk factors of stress ulcer after the operation of senile femoral shaft with ipsilateral femoral neck fracture.Methods The clinical data of 128 elderly patients with femoral shaft and ipsilateral femoral neck fractures admitted to the Second Affiliated Hospital of Air Force Military Medical University from Dec.2012 to Dec.2022 was retrospectively analyzed,and the incidence of the postoperative stress ulcer in the patients was statistically analyzed.Single factor and multivariate Logistic regression analysis were adopted to analyze the risk factors for the stress ulcer after surgery.Results Among the 128 elderly patients,31 patients(24.22%)developed stress ulcer within 2 weeks after operation.The patientage,proportions of long-term use of non-steroidal anti-inflammatory drugs,history of peptic ulcer,fracture caused by traffic accident,surgical anesthesia time≥2 hours,and mechanical ventilation time≥48 hours in the stress ulcer group were all significantly higher than those in the non-stress ulcer group[(81±6)years old vs(79±6)years old,54.84%(17/31)vs 22.68%(22/97),54.84%(17/31)vs 13.40%(13/97),80.65%(25/31)vs 57.73%(56/97),61.29%(19/31)vs 34.02%(33/97),41.94%(13/31)vs 14.43%(14/97)](P<0.05 or P<0.01).Multivariate Logistic analysis showed that older age,long-term use of non-steroidal anti-inflammatory drugs,history of peptic ulcers,fracture caused by traffic accidents,surgical anesthesia time≥2 hours,mechanical ventilation time≥48 hours were risk factors for postoperative stress ulcers in elderly patients with femoral shaft and ipsilateral femoral neck fractures(OR=2.250,95%CI 1.694-2.806;OR=3.053,95%CI 2.468-3.637;OR=3.277,95%CI 2.509-4.045;OR=2.354,95%CI 1.715-2.992;OR=2.474,95%CI 1.812-3.137;OR=2.782,95%CI 2.064-3.499)(all P<0.01).Conclusion There are many risk factors for stress ulcer in elderly patients with femoral shaft and ipsilateral femoral neck fractures after surgery.In clinical treatment,attention should be paid to high-risk groups such as older people,long-term use of non-steroidal anti-inflammatory drugs,history of peptic ulcer,fracture causes of traffic accident,operation anesthesia time≥2 hours and mechanical ventilation time≥48 hours,and their condition changes should be paid close attention to,and timely intervention measures should be given.