骨科老年患者围手术期并发症相关危险因素评估  

Risk factors for perioperative complications in orthopedic aged patients

作　　者：余江[1] 蒋科[1] 吴思宇[1] 王爱民[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所骨科,重庆400042

出　　处：《第三军医大学学报》2013年第11期1160-1163,共4页Journal of Third Military Medical University

摘　　要：目的研究骨科老年患者围手术期并发症相关危险因素。方法对2008年1月至2012年8月在我院骨科行骨科手术的1024例老年患者临床资料进行回顾性研究。男性388例,女性636例,年龄60～96(72.82±8.37)岁。行关节置换436例,骨折手术229例,脊柱手术158例,骨软组织感染手术112例,其他手术89例。出院为观察终点。收集骨科老年患者临床资料,包括合并疾病、术前指标、术中指标、围手术期并发症。分析导致围手术期并发症相关危险因素。结果围手术期总并发症例数为214例,占20.9%。通过Logistic多元逐步回归分析,术前合并高血压病和脑血管疾病、心功能Ⅱ级以上、心率增快、美国麻醉师学会生理状态评分系统(ASA)分级≥3级、白细胞>10×109/L、低血红蛋白、低白蛋白、全身麻醉、手术时间≥3h为骨科老年患者围手术期并发症危险因素(P<0.05)。结论骨科老年患者围手术期并发症发生率高,围手术期并发症危险因素主要为术前合并高血压病和脑血管疾病、心功能Ⅱ级以上、心率增快、ASA分级≥3级、白细胞>10×109/L、低血红蛋白、低白蛋白的、全身麻醉、手术时间≥3h。Objective To investigate the risk factors of perioperative complications in elderly patients in orthopedic department. Methods A total of 1 024 aged patients receiving orthopedic surgery in our department from January 2008 to August 2012 were enrolled and retrospectively analyzed in this study. They were 388 males and 636 females, with an age ranging from 60 to 96 years old, mean 72.82±8.37. There were 436 cases of joint replacement, 229 cases of fracture surgery, 158 cases of spinal surgery, 112 cases of operation of bone and soft tissue infection, and 89 cases of other surgeries. Their clinical data, complications, preoperative, intra-operative and perioperative variables were analyzed. Binary-Logistic regression analysis was carried out to identify the risk factors for incidence of preoperative complications. Results There were 214 cases found having perioperative complications during hospitalization （20.9%）. After adjustment for multiple risk factors, the risk factors for perioperative complications were hypertension, cerebrovascular diseases, heart functional class Ⅱ or above, increased heart rate, American Society of Anesthesiologists Physical Status scoring system （ASA） grade≥3, WBC〉10×109/L, low hemoglobin, low albumin, general anesthesia, and operation time over 3 h（P〈0.05）. Conclusion The incidence of perioperative complications is high in orthopedic aged patients. Risk factors for perioperative complications were hypertension, cerebrovascular diseases, heart functional class Ⅱ or above, increased heart rate, ASA grade≥3, WBC〉10×109/L, low hemoglobin, low albumin, general anesthesia, and operation time over 3 h.

关 键 词：骨科 老年患者 并发症 危险因素 

分 类 号：R195.4[医药卫生—卫生统计学] R619[医药卫生—卫生事业管理]