老年骨关节置换术围术期发生脑梗死的危险因素分析及预防对策研究

Risk Factors of Perioperative Cerebral Infarction in Elderly Patients with Bone and Joint Replacement and Preventive Measures

目的:分析老年骨关节置换术围术期发生脑梗死的危险因素并研究其预防对策。方法:选择2015年1月-2016年6月我院收治的200例行关节置换术患者,对所有患者的性别、年龄、体重、身高、患病情况、置入假体类型、手术时间、术中出血量、术后引流量、切口长度、住院时间、下地时间及高血压、糖尿病、冠心病等合并症情况进行回归分析,明确患者围术期发生脑梗死的危险因素,并提出针对性预防措施。结果:入组200例行骨关节置换术患者,围术期发生脑梗死患者53例。单因素分析结果显示年龄是否超过65岁、吸烟与否、疾病类型、麻醉方式、有无冠心病、糖尿病、高血压等合并症的骨关节置换术患者围术期脑梗死的发生率存在显著性差异(P<0.05)。而进一步logistics回归分析显示年龄超过65岁、吸烟、患者股骨颈骨折、手术麻醉为全麻、有冠心病、糖尿病、高血压等合并症是影响行骨关节置换术患者围术期发生脑梗死的独立危险因素(P<0.05)。结论:年龄超过65岁、吸烟、患者股骨颈骨折、手术麻醉为全麻、有冠心病、糖尿病、高血压等合并症的骨关节置换术患者围术期更易发生脑梗死,对有上述特点患者应密切注意预后情况,给予精细的护理措施,防止脑梗死的发生。

Objective: To analyze the risk factors of perioperative cerebral infarction in elderly patients with bone and joint replacement and to study its prevention strategies. Methods: 200 cases of patients undergoing arthroplasty in our hospital from January2015 to June 2016 were selected, the gender, age, weight, height, prevalence, implantation, operation time, intraoperative blood loss,postoperative drainage, length of incision, hospital stay, time of getting out of bed, and past medical history of hypertension, diabetes,coronary heart disease, etc were retrospectively analyzed to indentify the risk factors of cerebral infarction in the perioperational period,and provide corresponding measures. Results: Of the 200 patients treated with osteoarthroplasty, 53 patients suffered from cerebral infarction during perioperative period. Single factor analysis results showed that there were distinctive differencesamong patients treated with osteoarthroplasty but suffering from cerebral infarction during perioperative period(P<0.05). Such differences lay in whether they were over 65 years old and smoking, and diseases like coronary heart disease, diabetes and hypertension. Differences were associated with the way of anesthesia as well. Furthermore, logistics regression analysis demonstrates there were numerous sole dangerous factors that influence patients treated with osteoarthroplasty but suffering from cerebral infarction during perioperative period. Patients who were over 65-year-old and had a habit of smoking with general anesthesia, femoral neck fracture, coronary heart disease, diabetes and hypertension were more likely to suffer from cerebral infarction(P<0.05). Conclusion: Patients with age>65-year-old, smoking, fracture of neck of femur, general anesthesia, past medical history of hypertension, diabetes, coronary heart disease were more easily to suffer from cerebral infarction. To avoid cerebral infarction, these patients are supposed to deserve careful nursing, and much attention should be paid to the prognosis.