老年髋部骨折患者术前低氧血症的危险因素分析  

Risk factors of preoperative hypoxemia in geriatric patients with hip fracture

作　　者：高宇澄 石柳[1,2,3,4] 高旺[1,2,3,4] 谢添 张曦文[4,5] 刘敏 陈翔溆[1,2,3,4] 张程[1,2,3,4] 范文斌[1,2,3,4] 崔学良 钱玉雷[1] 李荥娟[4,6] 陈辉 芮云峰 Gao Yucheng;Shi Liu;Gao Wang;Xie Tian;Zhang Xiwen;Liu Min;Chen Xiangxu;Zhang Cheng;Fan Wenbin;Cui Xueliang;Qian Yulei;Li Yingjuan;Chen Hui;Rui Yunfeng(Department of Orthopedics,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Trauma Center,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Institute of Traumatic Orthopedics,Southeast University,Nanjing 210009,China;Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Department of Critical Care Medicine,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Department of Geriatrics,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院骨科,南京210009 [2]东南大学附属中大医院创伤中心,南京210009 [3]东南大学创伤骨科研究所,南京210009 [4]东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组,南京210009 [5]东南大学附属中大医院重症医学科,南京210009 [6]东南大学附属中大医院老年科,南京210009

出　　处：《中华创伤杂志》2022年第5期436-443,共8页Chinese Journal of Trauma

摘　　要：目的探讨老年髋部骨折患者术前低氧血症的危险因素。方法采用病例对照研究分析2020年11月至2021年8月东南大学附属中大医院收治的99例老年髋部骨折患者临床资料,其中男29例,女70例;年龄67~96岁[(82.6±6.2)岁]。以急诊就诊时吸入室内空气下动脉血氧分压(PaO2)<80 mmHg为参考标准,分为低氧血症组(51例)和非低氧血症组(48例)。比较两组性别、年龄、骨折类型、体重指数(BMI)、美国麻醉师协会(ASA)分级、术前胸部CT诊断的肺部疾病[肺不张、胸腔积液、慢性阻塞性肺疾病(COPD)]、受伤至就诊时间、美国纽约心脏协会(NYHA)心功能分级、Barthel指数、KATZ指数、改良版英国医学研究委员会(mMRC)呼吸困难评分、数字疼痛评分(NRS)、吸烟、饮酒、基础疾病(高血压、糖尿病、帕金森病、阿尔兹海默症、既往脑梗死、冠心病)、体温、首次血常规检查(红细胞计数、白细胞计数、C-反应蛋白、血红蛋白)、生化检查(血清白蛋白、血糖、血肌酐、血尿素氮)、电解质检查(血钠、血钾)及其他相关检查[D-二聚体、心房钠尿肽(BNP)、乳酸]。采用单因素分析上述指标与术前低氧血症的相关性,采用多因素Logistic回归分析明确老年髋部骨折术前低氧血症的独立危险因素。结果两组性别、年龄、骨折类型、BMI、术前CT诊断的肺部疾病、受伤至就诊时间、Barthel指数、KATZ指数、NRS、吸烟、饮酒、基础疾病、体温、首次红细胞计数、生化检查、电解质检查、其他相关检查差异无统计学意义(P均>0.05);ASA分级、NYHA心功能分级、mMRC呼吸困难评分、首次白细胞计数、C-反应蛋白及血红蛋白差异有统计学意义(P均<0.05)。单因素分析结果显示,ASA分级、NYHA心功能分级、mMRC呼吸困难评分、首次白细胞计数、C-反应蛋白与老年髋部骨折术前低氧血症有一定相关性(P均<0.05)。多因素Logistic回归分析结果表明,mObjective To investigate the risk factors for preoperative hypoxemia in geriatric patients with hip fracture.Methods A case-control study was used to analyze the clinical data of 99 geriatric patients with hip fracture admitted to Zhongda Hospital affiliated to Southeast University between November 2020 and August 2021.There were 29 males and 70 females,aged 67-96 years[(82.6±6.2)years].The patients were divided into hypoxemia group(n=51)and non-hypoxemia group(n=48)using partial arterial partial pressure of oxygen(PaO2)<80 mmHg while breathing room air at emergency as the reference standard.The two groups were compared in terms of sex,age,fracture types,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,pulmonary diseases diagnosed by preoperative chest CT[atelectasis,pleural effusion,chronic obstructive pulmonary disease(COPD)],time from injury to visit,New York Heart Association(NYHA)classification,Barthel index,KATZ index,modified Medicine Research Council(mMRC)dyspnea scale,numeric rating scale(NRS),smoking,drinking,comorbidities(hypertension,diabetes mellitus,Parkinson′s disease,Alzheimer′s disease,cerebral infarction,coronary atherosclerotic heart disease),body temperature,blood routine test at first examination(erythrocyte count,leukocyte count,C-reactive protein,hemoglobin),biochemistry(serum albumin,blood glucose,blood creatinine,blood urea nitrogen),electrolyte(serum potassium,serum sodium),and other related examinations[D-dimer,brain natriuretic peptide(BNP),lactic acid].Univariate analysis was performed to the correlation of those indicators with preoperative hypoxemia.Multivariate Logistic regression analysis was used to identify the independent risk factors for preoperative hypoxemia in geriatric patients with hip fracture.Results Differences in sex,age,fracture types,BMI,pulmonary diseases diagnosed by preoperative chest CT,time from injury to visit,Barthel index,KATZ index,NRS,smoking,drinking,comorbidities,body temperature,first laboratory results of erythrocyte c

关 键 词：髋骨折 老年人 危险因素 术前低氧血症 

分 类 号：R687.3[医药卫生—骨科学]