对高龄髋部骨折患者术后一年病死率及病死危险因素的分析  

Mortality and risk factors of death one year after surgery in patients aged 80 years and over with hip fracture

作　　者：孟衍蓉 刘利民[1] Meng Yanrong;Liu Limin(Department of Orthopedic,Xuanwu Hospital,Capital Medical University,Beijing 100853,China)

机构地区：[1]首都医科大学宣武医院骨科,100053

出　　处：《骨科临床与研究杂志》2022年第6期339-344,共6页Journal Of Clinical Orthopedics And Research

基　　金：首都卫生发展科研专项(2016-1-5092)。

摘　　要：目的探讨80岁及以上髋部骨折患者术后1年病死率及病死危险因素。方法对2016年1月至2019年12月首都医科大学宣武医院骨科收治的80岁及以上髋部骨折患者290例的临床资料进行回顾性分析。其中男86例,女204例;年龄(85.1±4.05)(80~100)岁。收集患者一般临床资料(年龄和性别),住院资料[骨折部位、手术方式、住院时间、受伤至手术时间、手术进行时段、手术时长、术中出血量、实验室检查指标、心脏左室射血分数(LVEF)、术前控制营养状况(CONUT)评分、术前合并症、术后是否发生肺部感染、是否吸烟、是否进行康复训练]和术后资料(是否存活和是否进行康复训练)。根据术后1年是否生存将全部患者分为生存组(220例)和病死组(70例)。对两组数据进行单因素分析,对其中P<0.1的单因素进一步进行多因素logistic二元回归分析,筛选出患者术后1年发生病死的危险因素。结果290例患者术后1年病死率为24.1%(70/290)。单因素分析结果显示,年龄、白蛋白水平、CONUT评分、LVEF、康复训练、吸烟、焦虑和抑郁以及肺部感染是80岁及以上髋部骨折患者术后1年内病死的相关因素(均P<0.05)。多因素logistic二元回归分析结果显示,焦虑和抑郁、吸烟、CONUT评分高以及肺部感染是80岁及以上髋部骨折患者术后1年高病死率的独立危险因素(均P<0.05)。结论80岁及以上髋部骨折患者术后1年病死率为24.1%。年龄、白蛋白水平、CONUT评分、心脏LVEF、康复训练、吸烟、焦虑和抑郁、肺部感染是80岁及以上髋部骨折患者术后1年内病死的相关因素,其中焦虑和抑郁、吸烟、CONUT评分高以及肺部感染是独立危险因素。Objective To investigate mortality and risk factors of death one year after surgery in patients aged 80 years and over with hip fracture.Methods Clinical data of 290 patients aged 80 years and over with hip fracture underwent surgery in the Department of Orthopedics,Xuanwu Hospital,Capital Medical University from January 2016 to December 2019 were analyzed retrospectively.There were 86 males and 204 females aged(85.1±4.05)(80-100)years.General clinical data(age and sex),hospitalization data(fracture site,operation method,length of hospital stay,time from injury to operation,operation period,operation time,intraoperative blood loss,laboratory test indicators,left ventricular ejection fraction(LVEF)of heart,Controlling Nutritional Status(CONUT)score,preoperative comorbidities,postoperative pulmonary infection,smoking,rehabilitation training)and postoperative data(death or life and rehabilitation training)were included.All patients were divided into survival group(n=220)and death group(n=70)according to whether they sruvived one year after operation.Univariate analysis and multivariate logistic binary regression analysis were used to screen out the risk factors of one-year postoperative mortality.Results The one-year postoperative mortality was 24.1%(70/290).Univariate analysis showed that the mortality in one year after surgery in the patients was significantly different(all P<0.05)in terms of age,albumin level,CONUT score,LVEF,rehabilitation training,smoking,anxiety and depression and lung infection.Multivariate logistic binary regression analysis showed that anxiety and depression,smoking,high CONUT score,and pulmonary infection were independent risk factors for high one-year mortality in the patients(all P<0.05).Conclusion One-year postoperative mortality of patients aged 80 and over with hip fracture is 24.1%.Age,albumin level,CONUT score,LVEF,rehabilitation training,smoking,anxiety and depression and pulmonary infection are risk factors for one-year postoperative death in elderly patients aged 80 years and ov

关 键 词：髋骨折 死亡率 危险因素 焦虑 抑郁 吸烟 营养状况 肺 感染 老年人 80以上 

分 类 号：R687.3[医药卫生—骨科学]