老年股骨转子间骨折患者围术期低钠血症发生现状及影响因素分析

Analysis of the current status and influencing factors of perioperative hyponatremia in elderly patients with intertrochanteric fractures of the femur

目的探讨老年股骨转子间骨折患者围术期低钠血症的发生现状及影响因素。方法前瞻性队列研究。抽取2021年2月至2023年2月郑州大学附属郑州中心医院骨科接受手术治疗的老年股骨转子间骨折120例患者作为研究对象,围术期监测所有患者血钠浓度,术前、术后根据患者的血钠浓度判定其低钠血症发生情况,血钠浓度<135 mmol/L视为低钠血症,将发生低钠血症者纳入发生组,未发生者纳入未发生组。自制资料调查问卷,调查患者基本情况,记录实验室相关检查重要指标(为术前检查结果),分析围术期老年股骨转子间骨折患者发生低钠血症的影响因素。结果120例老年股骨转子间骨折患者术前血钠浓度均>135 mmol/L,接受手术治疗后发生低钠血症者30例(25.00%,30/120);初步经卡方与独立样本t检验比较发生与未发生低钠血症患者的资料与实验室指标,结果显示,发生组与未发生组术前白蛋白、血尿素氮、血清肌酐水平和氯离子浓度比较差异有统计学意义(P<0.05),组间其他资料比较差异有统计学意义(P>0.05);Logistic回归分结果显示,老年股骨转子间骨折患者术前白蛋白水平、血尿素氮、血清肌酐水平异常过表达是围术期低钠血症发生的影响因素,其中白蛋白异常升高是其保护因素(OR<1,P<0.05),血尿素氮、血清肌酐水平异常过表达是其危险因素(OR>1,P<0.05)。结论老年股骨转子间骨折患者围术期间低钠血症发生风险较高,且多在术后发生,可能与患者术前白蛋白、血尿素氮、血清肌酐水平有关。

Objective To investigate the current status and influencing factors of perioperative hyponatremia in elderly patients with intertrochanteric fractures of the femur.Methods This study was prospective cohort trail.A tota of 120 elderly patients with intertrochanteric fractures of the femur who received surgical treatment in the Department of Orthopaedics of Zhengzhou Central Hospital Affiliated to Zhengzhou University from February 2021 to February 2023 were selected as the research objects.The serum sodium concentration of the patients was monitored during the perioperative period.The occurrence of hyponatremia was determined according to the serum sodium concentration before and after the operation.The patients with serum sodium concentration<135 mmol/L were diagnosed with hyponatremia,which were included in the occurrence group,and patients without hyponatremia were included in the non-occurrence group.A self-made data survey questionnaire was designed to investigate the basic situation of patients and record important laboratory examination indicators(preoperative examination results).The influencing factors of hyponatremia in elderly patients with intertrochanteric fractures of the femur during the perioperative period were analyzed.Results The preoperative level of serum sodium concentration in the 120 elderly patients with intertrochanteric fractures of the femur were all>135 mmol/L.Thirty patients(25.00%,30/120)developed hyponatremia after surgery.The results of preliminarily chi square and independent sample t test for comparison of the data and laboratory indicators between patients with and without hyponatremia showed that there were significant differences in preoperative levels of albumin,blood urea nitrogen,serum creatinine and chloride ion concentration between the occurrence group and the non-occurrence group(P<0.05),and there were no differences in other data between the two groups(P>0.05).Results of logistic regression analysis showed that the abnormal overexpressions of albumin,blood urea nitrogen and serum creatinine in elderly patients with intertrochanteric fracture of the femur before operation were the influencing factors of the occurrence of perioperative hyponatremia,of which the abnormal overexpression of albumin was the protective factor(OR<1,P<0.05),and of which the abnormal overexpression of blood urea nitrogen and serum creatinine were the risk factors(OR>1,P<0.05).Conclusions The risk of hyponatremia in elderly patients with intertrochanteric fracture of the femur during perioperative period is high.Moreover,the disease mostly occurs after surgery,which may be related to the preoperative levels of albumin,blood urea nitrogen,and serum creatinine.