合并慢性阻塞性肺疾病的老年髋部骨折患者术后1、5年死亡的相关因素分析  

Factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease

作　　者：王晓伟[1] 征华勇 李绍光[1] 张建政[1] 刘智 孙天胜 Wang Xiaowei;Zheng Huayong;Li Shaoguang;Zhang Jianzheng;Liu Zhi;Sun Tiansheng(Department of Orthopaedics,The 7th Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第7医学中心骨科,北京100700

出　　处：《中华创伤骨科杂志》2022年第1期46-53,共8页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨合并慢性阻塞性肺疾病(COPD)的老年髋部骨折患者术后1、5年死亡的相关因素。方法回顾性分析2012年1月至2016年12月解放军总医院骨科学部收治的老年髋部骨折患者资料, 期间共收治合并COPD的老年髋部骨折患者103例, 在不合并COPD老年髋部骨折患者中根据性别、年龄、骨折部位进行1∶1配对, 筛选出103例患者作为非COPD组。比较两组患者术后30 d、1年、5年的死亡率, 探讨老年髋部骨折合并COPD患者术后1、5年死亡的相关因素。结果 COPD组患者术后30 d、1年和5年死亡率分别为7.8%(8/103)、29.1%(30/103)和48.5%(50/103), 高于非COPD组[1.9%(2/103)、13.6%(14/103)和31.1%(32/103)], 除术后30 d, 其余差异均有统计学意义(P<0.05)。高龄(P=0.003)、心血管系统疾病(P=0.006)、呼吸系统疾病(P=0.009)、急性发作期COPD(P<0.01)、美国麻醉师协会(ASA)Ⅲ+Ⅳ级(P=0.001)、延迟手术(> 48 h)(P=0.015)、伤前日常生活能力(ADL)评分(P=0.002)和行动能力(P=0.010)与术后1年死亡风险增加相关。高龄(OR=1.106, 95%CI: 1.016~1.210,P=0.021)、急性发作期COPD(OR=5.053, 95%CI: 1.520~16.800,P=0.008)、ASA Ⅲ+Ⅳ级(OR=1.657, 95%CI: 1.072~3.912,P=0.040)是COPD患者术后5年死亡的危险因素, 伤前ADL(OR=0.974, 95%CI: 0.987~0.967,P=0.043)与术后5年死亡呈负相关。结论 COPD会显著增加老年髋部骨折患者术后短期和长期死亡率, 心血管系统疾病、急性发作期COPD、ASA Ⅲ+Ⅳ级、延迟手术(>48 h)与COPD患者术后1年死亡相关, 高龄、急性发作期COPD、ASA Ⅲ+Ⅳ级是COPD患者术后5年死亡的独立危险因素, 而伤前ADL评分与术后1、5年死亡均呈负相关。Objective To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease(COPD).Methods A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics,The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them,103 were complicated with COPD,and another 103 without COPD were selected as controls who were matched in age,gender and fracture site.The 2 groups were compared in terms of postoperative 30-day,1-year and 5-year mortalities;the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results The postoperative 30-day,1-year and 5-year mortalities in the COPD group were 7.8%(8/103),29.1%(30/103)and 48.5%(50/103),significantly higher than those in the control group except for the 30-day value[1.9%(2/103),13.6%(14/103)and 31.1%(32/103)](P<0.05).Advanced age(P=0.003),cardiovascular disease(P=0.006),respiratory disease(P=0.009),acute exacerbation of COPD(AECOPD)(P<0.01),American Society of anesthesiologists(ASA)gradesⅢ+Ⅳ(P=0.001),delayed surgery(>48 h)(P=0.015),pre-injury activities of daily living(ADL)score(P=0.002)and mobility(P=0.010)were related to an increased risk for 1-year mortality after operation.Advanced age(OR=1.106,95%CI:1.016 to 1.210,P=0.021),AECOPD(OR=5.053,95%CI:1.520 to 16.800,P=0.008),and ASA gradesⅢ+Ⅳ(OR=1.657,95%CI:1.072 to 3.912,P=0.040)were the risk factors for 5-year mortality in patients with COPD;pre-injury ADL(OR=0.974,95%CI:0.987 to 0.967,P=0.043)was negatively correlated with 5-year mortality.Conclusions COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease,AECOPD and ASA gradesⅢ+Ⅳare factors related to postoperative 1-year mortality in patients with hip fracture plus COPD.Advanced age,AECOPD and ASA gradesⅢ+Ⅳand delayed surgery(>

关 键 词：髋骨折 肺疾病 慢性阻塞性 死亡率 老年人 

分 类 号：R687.3[医药卫生—骨科学] R563.9[医药卫生—外科学]