人工髋和膝关节置换术后患者住院期间病死率及病死的危险因素分析  

In-hospital mortality and risk factors after total hip or knee arthroplasty

作　　者：杜辉[1] 尹星华 黄勇[1] 邵宏翊[1] 周一新[1] Du Hui;Yin Xinghua;Huang Yong;Shao Hongyi;Zhou Yixin(Department of Orthopedic Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《骨科临床与研究杂志》2018年第5期289-294,共6页Journal Of Clinical Orthopedics And Research

基　　金：北京市科技计划(Z171100001017250)~~

摘　　要：目的探讨我国人工髋和膝关节置换术后患者住院期间病死率及病死的原因和危险因素。方法采用北京积水潭医院人工关节登记系统和病案室的病历回顾分析2010年1月至2016年5月在该院接受人工髋和膝关节初次置换或翻修手术患者的临床资料,提取在住院期间发生病死的病例并分析其病死原因,计算病死率并对危险因素进行相应统计学分析。结果纳入病例16 734例,其中13例住院期间病死,病死率为0.78‰。年龄为70~79岁的患者病死率为2.16‰,年龄为80岁以上患者的病死率为5.29‰,相对于60岁以下患者的病死率(0.13‰),差异均有统计学意义(P=0.010,0.009)。依据美国麻醉医师协会(ASA)分级标准,术前ASAⅠ级病例病死率为0.19‰,而ASAⅢ~Ⅳ级病例病死率为10.81‰,显著高于前者(P<0.001)。男性患者病死率为1.11‰,女性患者病死率为0.72‰,差异无统计学意义(P=0.292)。人工髋和膝关节翻修术术后患者病死率为2.61‰,初次单侧人工髋或膝关节置换术术后患者病死率为0.68%,二者差异无统计学意义(P=0.085)。结论患者接受人工髋或膝关节置换术后住院期间的病死率与患者的年龄和术前ASA分级密切相关,高龄患者和ASA分级高的患者病死率高。Objective To investigate the in-hospital mortality after total hip or knee arthroplasty and related risk factors in Chinese population.MethodsThe patients who underwent primary or revised total hip or/and knee arthroplasty in Beijing Jishuitan Hospital between January 2010 and May 2016 were reviewed.Those patients died in hospital and the reasons of death were recorded.The risk factors were analyzed statistically.Results Among the 16 734 cases who met the inclusion criteria,13 patients died in hospital with the in-hospital mortality of 0.78‰.The mortality of the patients aged from 70 to 79 was 2.16‰,whereas the mortality of the patients aged 80 and above was 5.29‰.Both of them were statistically higher than that of patients under 60 years of age（0.13‰）（P=0.010,0.009）.In terms of preoperative ASA score,the mortality of patients with ASAⅠwas 0.19‰,whereas the mortality of patients with ASAⅢ-Ⅳwas10.81‰,which was statistically different（P〈0.001）.The mortality of male patients was 1.11‰,which was not statistically different from that of female（0.72‰,P=0.292）.The mortality after revised total hip or knee arthroplasty was 2.61‰,whereas the mortality after unilateral primary total hip or knee was 0.68%,and there was no statistical difference between them（P=0.085）.ConclusionOld age and high ASA level were closely related with high in-hospital mortality after total hip or knee arthroplasty.

关 键 词：关节成形术 置换 髋 关节成形术 置换 膝 医院死亡率 死亡原因 危险因素 

分 类 号：R687.4[医药卫生—骨科学]