老年髋部骨折患者术后转ICU的影响因素分析  

Risk factors of the ICU admission in elderly hip fracture patients after surgery

作　　者：孙莉莉[1] 张明清 毕然 赵斌[1] Sun Lili;Zhang Mingqing;Bi Ran;Zhao Bin(Department of Emergency,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院急诊科,北京100035

出　　处：《中国医刊》2022年第4期425-429,共5页Chinese Journal of Medicine

摘　　要：目的探讨老年髋部骨折患者术后转ICU的影响因素。方法回顾性分析2017年1月至2018年1月北京积水潭医院收治的399例老年(年龄≥65岁)髋部骨折患者临床资料,将术后7d内转入ICU的患者作为观察组,未转入ICU的患者作为对照组。应用logistic回归分析老年髋部骨折患者术后转ICU治疗的独立危险因素。结果399例患者中有74例(18.5%)术后转入ICU。单因素分析显示,两组患者在年龄,合并症数量,术前合并肺部感染、心血管疾病、消化性溃疡、脑卒中例数,术前血红蛋白、白蛋白、动脉氧分压、血浆肌钙蛋白T、N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、左心室射血分数和骨折至手术时间等方面差异有显著性(P<0.05)。多因素logistic回归分析显示,术前合并肺部感染(OR=8.118,95%CI 1.624~40.576)、心血管疾病(OR=2.991,95%CI 1.324~6.753)、消化性溃疡(OR=2.743,95%CI 1.103~6.821)、脑卒中(OR=3.832,95%CI 1.703~8.586)及NT-proBNP水平(OR=1.001,95%CI 1.001~1.002)是老年髋部骨折患者术后转ICU的独立危险因素。结论老年髋部骨折患者术后转ICU的高危因素包括术前合并肺部感染、心血管疾病、消化性溃疡、脑卒中以及NT-proBNP水平升高。Objective To identify the risk factors of the ICU admission in elderly patients with hip fracture after surgery.Method The clinical data of 399 cases of elderly patients(aged 65 years or older)with hip fracture treated in Beijing Jishuitan Hospital from January 2017 to January 2018 were selected.The patients were divided into observation group and control group according to whether they were admitted to ICU within 7 days after operation.Multi-factor logistic regression analysis to stratify the risk factors of the ICU admission following hip fracture surgery in elderly patients.Result Among the 399 patients,74 elderly hip fracture patients(18.5%)were admitted to the ICU after operation.There were statistical differences between the ICU group and the non-ICU group in age,number of comorbidities,preoperative pulmonary infection,cardiovascular disease,peptic ulcer,stroke,preoperative hemoglobin,albumin,oxygen partial pressure,cTnT,NT-proBNP,left ventricular ejection fractions and wait time before surgery between the two groups(P<0.05).Multivariate logistic analysis showed that pulmonary infection(OR=8.118,95%CI 1.624-40.576),cardiovascular disease(OR=2.991,95%CI 1.324-6.753),peptic ulcer(OR=2.743,95%CI 1.103-6.821),stroke(OR=3.832,95%CI 1.703-8.586)and higher NT-proBNP(OR=1.001,95%CI 1.001-1.002)were independent risk factors of the ICU admission following hip fracture surgery in elderly patients.Conclusion Preoperative pulmonary infection,cardiovascular disease,peptic ulcer,stroke,and higher NT-proBNP were independent risk factors of the ICU admission in elderly hip fracture patients after surgery.

关 键 词：髋部骨折 老年 危险因素 重症监护病房 

分 类 号：R574[医药卫生—消化系统]