老年髋部骨折患者术后新发心脏不良事件的危险因素  

Risk factors for new cardiac adverse events in the elderly after hip fracture operation

作　　者：杨波[1] 杨晋才[2] 臧传义[1] 梁智林[1] 赵小林[1] 陈晓丽[3] YANG Bo;YANG Jin-Cai;ZANG Chuan-Yi;LIANG Zhi-Lin;ZHAO Xiao-Lin;CHEN Xiao-Li(First Department of Orthopaedics,Beijing Geriatric Hospital,Beijing 100095,China;Department of Orthopaedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Cardiology,Beijing Geriatric Hospital,Beijing 100095,China)

机构地区：[1]北京老年医院骨一科,北京100095 [2]首都医科大学附属北京朝阳医院骨科,北京100020 [3]北京老年医院心血管内科,北京100095

出　　处：《中华老年多器官疾病杂志》2020年第7期515-519,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：科技部国家重点研发计划项目横向课题(2016YFC110100);北京老年医院“525”人才培养科研专项。

摘　　要：目的研究老年髋部骨折患者术后住院期间新发心脏不良事件的危险因素。方法回顾性分析2014年7月至2018年6月在北京老年医院骨科所有住院的≥65岁的髋部骨折患者,收集所有患者的基线资料、术前合并症、麻醉方式等,分析其术后新发心脏不良事件的临床特点及危险因素。采用SPSS 22.0软件进行数据处理。对单因素分析有统计学意义的指标进行多因素logistic回归分析。结果共纳入418例患者,住院(13.2±6.8)d,年龄(76.7±9.2)岁,住院期间新发心脏不良事件56例(发生事件组),发生率为13.4%,其中因心脏事件死亡3例,死亡率0.72%。未发生心脏不良事件362例(未发生事件组)。2组患者异常心电图、左室射血分数≥50%、血红蛋白≥90g/L、血清白蛋白≥33g/L、B型脑钠肽前体≥450pg/ml、全身麻醉、术后电解质紊乱比例比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,心血管系统疾病史(OR=13.58,95%CI 10.12~21.39;P<0.01)、合并≥4种内科基础疾病(除心血管系统)(OR=5.28,95%CI 1.21~15.25;P<0.01)、美国麻醉医师协会(ASA)Ⅲ/Ⅳ级(OR=4.01,95%CI 3.24~10.34;P<0.01)、年龄≥70岁(OR=2.86,95%CI 1.05~7.55;P<0.05)、血清白蛋白<33g/L(OR=2.61,95%CI 1.23~5.51;P<0.01)、血红蛋白<90g/L(OR=1.81,95%CI 1.03~6.21;P<0.01)、术后电解质紊乱(OR=1.11,95%CI 1.02~2.34;P<0.01)是老年髋部骨折患者术后新发心脏不良事件独立危险因素。结论老年髋部骨折术后发生心脏不良事件是多种因素共同作用的结果,对于既往有心血管系统疾病史的患者应给与特别关注。Objective To study the risk factors for new cardiac adverse events during post-operative hospitalization in the elderly patients with hip fracture.Methods A retrospective analysis was conducted on the elderly patients over aged 65 years with hip fracture undergoing surgical treatment in Beijing Geriatric Hospital from July 2014 to June 2018.Their baseline data,preoperative complications and anesthetic modes were collected and analyzed for the clinical features and risk factors of new cardiac adverse events during hospitalization.The data were processed with SPSS statistics 22.0.Multivariate logistic regression analysis was used to analyze the statistically significant indices found by univariate logistic regress analysis.Results A total of 418 patients were enrolled in this study,and they are at a mean age of(76.7±9.2)years and had an average length of hospital stay of(13.2±6.8)d.There were 56 cases reporting new adverse cardiac events during hospitalization(13.4%,cardiac events group).Three patients died due to cardiac events,accounting for 0.72%(3/418).And the left 362 cases were assigned into the non-cardiac events group.Significant differences were seen in the ratios of patients with abnormal electrocardiogram,left ventricular ejection fraction≥50%,hemoglobin≥90g/L,albumin≥33g/L,pro-B-type natriuretic peptide≥450 pg/ml,general anesthesia and electrolyte disturbance after operation between the cardiac and non-cardiac events groups(P<0.05).Multivariate logistic analysis showed that the history of cardiovascular diseases(OR=13.58,95%CI 10.12-21.39;P<0.01),combination of basic diseases of internal medicine(except cardiovascular system)>4(OR=5.28,95%CI 1.21-15.25;P<0.01),ASA gradeⅢ/Ⅳ(OR=4.01,95%CI 3.24-10.34;P<0.01),age>70 years(OR=2.86,95%CI 1.05-7.55;P<0.05),serum albumin<33g/L(OR=2.61,95%CI 1.23-5.51;P<0.01),hemoglobin<90g/L(OR=1.81,95%CI 1.03-6.21;P<0.01),electrolyte disturbance(OR=1.11,95%CI:1.02-2.34;P<0.01)were independent risk factors for new cardiac adverse events in elderly pati

关 键 词：老年人 髋部骨折 心脏不良事件 危险因素 

分 类 号：R541[医药卫生—心血管疾病]