高龄髋部骨折术后院内死亡的危险因素分析  

Risk factor analysis for postoperative mortality in hospital of geriatric hip fracture patients

作　　者：常晓[1] 张保中[1] 翁习生[1] 林进[1] 张万利[1] 金今[1] 张嘉[1] 钱文伟[1] 高鹏[1] 邹雄飞[1] 唐璜[1] Chang Xiao;Zhang Baozhong;Weng Xisheng;Lin Jin;Zhang Wanli;Jin Jin;Zhang Jia;QianWen wei;Gao Peng;Zou Xiongfei;Tang Huang(Department of Orthopaedics, Peking Union Medical College Hospital, Beijing 100730, China)

机构地区：[1]北京协和医院骨科,100730

出　　处：《中华老年骨科与康复电子杂志》2017年第1期43-49,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费项目(2015PT320014)

摘　　要：目的探讨高龄髋部骨折患者术后院内死亡的危险因素。方法回顾性分析2004年1月至2014年12月于北京协和医院骨科接受手术治疗且符合纳入标准的高龄髋部骨折患者480例(股骨颈骨折325例,股骨转子间骨折155例)。以术后结局(生存或院内死亡)为因变量,以性别、年龄、骨折类型、ASA评分、麻醉方式、手术方式等为自变量。其中院内死亡共计13例,作为死亡组;随机选取42例正常出院、术后生存期超过90 d的患者作为对照(生存组)。采用多因素Logistic回归分析引起术后院内死亡的危险因素。结果肺部感染和急性心梗是高龄髋部骨折患者院内死亡的主要直接原因,院内死亡率为2.71%。单因素分析示组间年龄(t=2.623,P<0.05)、合并症数目(x^2=6.302,P<0.05)与吸烟史(x^2=6.061,P<0.05)差异有统计学意义;多因素Logistic回归分析示年龄(Wald=5.209,P<0.05,OR=0.757)、合并症超过2种(Wald=4.915,P<0.05,OR=0.155)和吸烟史(Wald=6.853,P<0.05,OR=10.917)为导致患者院内死亡的独立危险因素。结论高龄髋部骨折患者术后肺部感染与心梗的风险较高,在治疗过程中不可忽视年龄因素,对于有吸烟史的患者要尤其关注。Objective To analyze the risk factors of postoperative in-hospital death in elderly hip fracture patients. Methods Four hundred and eighty patients (325 femoral neck fracture, 155 intertrochanteric fracture) treated in Peking Union Medical College Hospital from January 2004 to December 2014 were included in this retrospective study. Survival or in-hospital deaths (postoperative outcome) was chosen as the dependent variable, and gender, age, fracture type, ASA score, comorbidities and other parameters were tested as independent variable. Thirteen in- hospital death cases were assigned to death group. Forty-two cases survived at least 90 days postoperatively were randomly selected as control group. Multi-factor Logistic regression analysis was applied to evaluate the risk factor of postoperative in-hospital death.Results Pulmonary infection and acute myocardial infarction were two main direct causes of postoperative in- hospital death with 2.71%mortality. There was significant difference on age (t=2.623, P<0.05), comorbidities (c2=6.302, P<0.05),and smoking history (c2=6.061, P<0.05) by single factor analysis. Multi-factor Logistic regression analysis showed that age (Wald=5.209, P<0.05, OR=0.757), more than two complications (Wald=4.915, P=0.027,OR=0.155) and smoking history (Wald=6.853, P<0.05, OR=10.917) was independent risk factors of postoperative in-hospital death. Conclusions The risks of perioperative pulmonary infection and acute myocardial infarction were relatively higher in postoperative geriatric hip fractures. Attention should be paid on elderly patients with more comorbidity or smoking history

关 键 词：髋骨折 院内死亡率 高龄 危险因素 

分 类 号：R687.3[医药卫生—骨科学]