老年髋部骨折患者术后发生心力衰竭的危险因素及预后分析

Risk factors for heart failure after hip fracture surgery in the elderly patients and prognosis analysis

目的:分析老年髋部骨折患者术后住院期间发生心力衰竭的危险因素,探讨心力衰竭对老年髋部骨折患者预后的影响。方法:回顾性分析2012年1月至2019年12月期间解放军总医院第七医学中心收治的1 478例老年髋部骨折患者资料。男482例,女996例;年龄81(75,90)岁。根据术后住院期间是否发生心力衰竭将患者分为心力衰竭组和无心力衰竭组,比较两组患者的临床资料,将 P<0.05的变量纳入多因素logistic回归模型,分析老年髋部骨折患者术后发生心力衰竭的危险因素。比较两组患者术后30 d和1年病死率、住院时间及术后并发症发生情况等。 结果:7.0%(104/1 478)的患者术后发生心力衰竭。多因素logistic回归分析结果显示:高龄( OR=1.035,95% CI:1.006~1.065, P=0.018)、男性( OR=1.727,95% CI:1.125~2.651, P=0.012)、心律失常( OR=1.830,95% CI:1.104~3.031, P=0.019)、输血量多( OR=1.100,95% CI:1.001~1.209, P=0.048)、术前使用抗凝或抗血小板药物( OR=1.921,95% CI:1.053~3.505, P=0.033)是老年髋部骨折患者术后发生心力衰竭的危险因素。心力衰竭组患者术后30 d病死率为9.6%(10/104),术后1年病死率为22.1%(23/104),术后并发症发生率为32.7%(34/104),均显著高于无心力衰竭组患者[3.6%(49/1 374)、13.8%(190/1 374)、17.5%(241/1 374)];住院时间为14(11,19)d,显著长于无心力衰竭组患者[11(9,15)d],差异均有统计学意义( P<0.05)。 结论:高龄、男性、心律失常、输血量多和术前使用抗凝或抗血小板药物是老年髋部骨折患者术后发生心力衰竭的危险因素。发生心力衰竭的患者预后差,术后病死率高,并发症多,住院时间长。

ObjectiveTo explore the risk factors for heart failure after hip fracture surgery in the elderly patients and the impact of heart failure on their prognosis.MethodsA retrospective study was conducted to analyze the data of 1,478 elderly patients with hip fracture who had been admitted to The 7th Medical Center,General Hospital of the Chinese People's Liberation Army from January 2012 to December 2019.There were 482 males and 996 females with an age of 81(75,90)years.The patients were divided into a failure group and a failure-free group based on whether they had experienced any heart failure during postoperative hospitalization.After the clinical data were compared between the 2 groups,the variables with P<0.05 were included in the following multivariate logistic regression analysis to determine the risk factors for postoperative heart failure in the elderly patients with hip fracture.The mortality rates at 30 days and 1 year after operation,hospital stay,and incidence of postoperative complications were compared between the 2 groups.ResultsPostoperative heart failure occurred in 7.0%(104/1,478)of the patients.The multivariate logistic regression analysis showed that advanced age(OR=1.035,95%CI:1.006 to 1.065,P=0.018),male(OR=1.727,95%CI:1.125 to 2.651,P=0.012),arrhythmia(OR=1.830,95%CI:1.104 to 3.031,P=0.019),a high volume of blood transfusion(OR=1.100,95%CI:1.001 to 1.209,P=0.048),and preoperative use of anticoagulant or antiplatelet drugs(OR=1.921,95%CI:1.053 to 3.505,P=0.033)were risk factors for postoperative heart failure in the elderly patients with hip fracture.In the failure group,the mortality rates at 30 days and 1 year after operation were 9.6%(10/104)and 22.1%(23/104),and the incidence of postoperative complications was 32.7%(34/104),all significantly higher than those in the failure-free group[3.6%(49/1,374),13.8%(190/1,374),and 17.5%(241/1,374)](P<0.05).The hospitalization time for the failure group was 14(11,19)days,significantly longer than that for the failure-free group[11(9,15)days](P<0.05).ConclusionsAdvanced age,male,arrhythmia,a high volume of blood transfusion,and preoperative use of anticoagulant or antiplatelet drugs are risk factors for heart failure in the elderly patients after hip fracture surgery.Patients with heart failure may face poor prognosis,a high mortality rate,multiple complications,and long hospital stay.