髋部骨折后术前心力衰竭危险因素及预后分析  

Risk factors and prognosis of preoperative herat failure after hip fracture

作　　者：郭艳辉 王晔来 孙天胜 刘智 张建政[1] 王晓伟[1] GUO Yan-hui;WANG Ye-lai;SUN Tian-sheng;LIU Zhi;ZHANG Jian-zheng;WANG Xiao-wei(Department of Orthopaedics,the 7th Medical Center,General Hospital of the Chinese People's Liberation Army,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心骨科,北京100700

出　　处：《中国骨伤》2023年第12期1114-1119,共6页China Journal of Orthopaedics and Traumatology

基　　金：北京市自然科学基金(编号:7232165)。

摘　　要：目的:探讨老年髋部骨折患者术前心力衰竭发生率、危险因素及术前心力衰竭与预后的关系。方法:回顾性分析2012年1月至2019年12月收治的1 569例老年髋部骨折患者,男522例,女1 047例;年龄81.00(75.00,90.00)岁;股骨转子间骨折896例,股骨颈骨折673例。根据术前是否发生心力衰竭将患者分为心力衰竭和无心力衰竭组,将心力衰竭设为因变量,自变量包括年龄、性别、骨折类型、并存病和血液学指标等,先进行单变量分析,将有统计学差异的自变量纳入多因素Logistic回归分析,得出术前心力衰竭发生的独立危险因素。比较心力衰竭组和无心力衰竭组患者住院时间、围手术期并发症、术后30d和1年的死亡率。结果:心力衰竭组患者91例,男40例,女51例;年龄82.00(79.00,87.00)岁;股骨转子间骨折55例,股骨颈骨折36例。无心力衰竭组患者1 478例,男482例,女996例;年龄81.00(75.00,86.00)岁;股骨转子间骨折841例,股骨颈骨折637例。两组患者年龄、性别、冠心病、心律失常和痴呆方面比较,差异有统计学意义(P<0.05)。将具有统计学意义的因素带入多因素Logistic分析,结果显示男性(OR=1.609,P=0.032)、年龄(OR=1.032,P=0.031)、心律失常(OR=2.045,P=0.006)、痴呆(OR=2.106,P=0.014)是术前发生心力衰竭的独立危险因素。心力衰竭组患者术后30 d和1年死亡率分别为9.9%、26.4%,无心力衰竭组分别为3.6%、13.8%,两组比较差异有统计学意义(P<0.05)。两组患者在肺部感染、脑血管并发症和心血管并发症方面比较,差异有统计学意义(P<0.05)。心力衰竭组住院时间(16.21±10.64) d与无心力衰竭组(13.26±8.00)d比较,差异有统计学意义(t=2.513,P=0.012)。结论:男性、高龄、心律失常、痴呆是老年髋部骨折后心力衰竭的独立危险因素,术前发生心力衰竭的患者术后肺部感染脑血管和心血管并发症发生率高,术后30d和1年死亡率高,住院时间长。Objective To explore incidence,risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture.Methods A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019,including 522 males and 1 047 females,aged 81.00(75.00,90.00)years old;896 intertrochanteric fractures and 673 femoral neck fractures.Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery,and heart failure was set as the dependent variable,with independent variables including age,gender,fracture type,comorbidities and hematological indicators,etc.Univariate analysis was performed at first,and independent variables with statistical differences were included in multivariate Logistic regression analysis.Independent risk factors for preoperative heart failure were obtained.The length of hospital stay,perioperative complications,mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups.Results There were 91 patients in heart failure group,including 40 males and 51 females,aged 82.00(79.00,87.00)years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture.There were 1 478 patients in non-heart failure groups,including 482 males and 996 females,aged 81.00(75.00,86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture.There were significant differences in age,sex,coronary heart disease,arrhythmia and dementia between two groups(P<0.05).Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609,P=0.032),age(OR=1.032,P=0.031),arrhythmia(OR=2.045,P=0.006),dementia(OR=2.106,P=0.014) were independent risk factor for preoperative heart failure.The 30-day and 1-year mortality rates were9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group,respectively;and had statisti

关 键 词：老年 髋部骨折 心力衰竭 

分 类 号：R683.42[医药卫生—骨科学]