老年股骨粗隆间骨折术后急性肾损伤的危险因素分析  

Analysis of risk factors of postoperative acute kidney injury in elderly patients with intertrochanteric fractures

作　　者：袁鑫 聂铭 陈世荣[1] Yuan Xin;Nie Ming;Chen Shirong(Department of Orthopaedic Surgery,Second Afiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院关节外科,重庆400010

出　　处：《国际外科学杂志》2023年第3期184-189,共6页International Journal of Surgery

摘　　要：目的:探讨老年股骨粗隆间骨折患者手术后急性肾损伤(AKI)的危险因素。方法:回顾性分析2018年7月—2022年12月重庆医科大学附属第二医院收治的307例老年股骨粗隆间骨折患者的临床资料,根据术后患者是否发生AKI分为AKI和非AKI两组,其中AKI组33例,非AKI组274例。收集两组患者的年龄、性别、体重指数、基础疾病、查尔森合并症指数(CCI)、术前及术后相关实验室指标、美国麻醉医师协会分级、麻醉及手术方式、手术时长、术中低血压、是否输血、围手术期用药等病例资料进行比较。符合正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用t检验;偏态分布的计量资料以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ^(2)检验或Fisher确切概率法。对两组患者相关指标先做单因素分析,根据单因素分析结果选择差异具有统计学意义的指标纳入多因素Logistic回归分析,分析导致术后发生AKI的独立危险因素。结果:老年股骨粗隆间骨折患者术后AKI发生率约为10.75%。单因素分析结果显示,两组患者在糖尿病、慢性肾脏疾病、CCI≥2、基线血肌酐、术前血尿素氮、术前估算肾小球滤过率、术前及术后早期血清白蛋白水平、术中低血压、围手术期输血方面差异均具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,CCI≥2(OR=3.231,95%CI:1.150~9.074,P=0.026)、术中低血压(OR=4.617,95%CI:1.746~12.205,P=0.002)与老年股骨粗隆间骨折患者术后发生AKI有关。结论:CCI≥2、术中低血压是老年股骨粗隆间骨折患者术后发生AKI的独立危险因素。Objective:To investigate the risk factors of postoperative acute kidney injury(AKI)in the elderly patients with intertrochanteric fractures.Methods:The clinical data of elderly patients who underwent surgery for intertrochanteric fractures in Second Affiliated Hospital of Chongqing Medical University from July 2018 to December 2022 were retrospectively analyzed,which was divided into AKI group and non-AKI group according to whether AKI occurred after surgery,with 33 cases in the AKI group and 274 cases in the non-AKI group.The data from two groups of patients including age,gender,body mass index,underlying diseases,Charlson comorbidity index(CCI),pre-and postoperative related laboratory indicators,American Society of Anesthesiologists classification,anesthesia and surgical methods,operation time,intraoperative hypotension,blood transfusion,perioperative medication and other electronic case data were compared.Measurement data with normal distribution were represented as the mean±standard deviation(x±s),and comparison between groups was conducted using t-test.The measurement data of non-normal distribution were expressed by median(interquartile range)[M(Q_(1),Q_(3))],and the Mann-Whitney U test was used for comparison between groups.Comparison between groups of count data was conducted using the Chi-square test or Fisher exact test.Univariate analysis was conducted on the pertinent indicators of the two groups,and the indicators with statistically significant were chosen for incorporation into the multivariate Logistic regression analysis to investigate the independent risk factors for postoperative AKI.Results:The incidence of postoperative AKI was 10.75%in elderly patients with intertrochanteric fractures.Results of the univariate analysis showed that there were significant differences between the two groups in diabetes mellitus,chronic kidney disease,CCI≥2,baseline serum creatinine,preoperative blood urea nitrogen,preoperative estimated glomerular filtration rate,preoperative and early postoperative serum al

关 键 词：股骨粗隆间骨折 急性肾损伤 危险因素 查尔森合并症指数 术中低血压 

分 类 号：R687.3[医药卫生—骨科学] R692[医药卫生—外科学]