影响初次单侧髋膝关节置换术术后住院时间的因素分析  

Analysis of the predictors of postoperative length of stay in patientswith primary unilateral hip and knee joint replacement

作　　者：马熠[1] 方开云[1] 彭晶[1] 王璐 孙立[2] 朱焱 Ma Yi;Fang Kaiyun;Peng Jing;Wang Lu;Sun Li;Zhu Yan(Department of Anesthesiology,Guiyang 550002,China;Department of Orthopaedics Guizhou Provincial People's Hospital,Guiyang 550002,China;Department of Statistics,School of Public Health,University of Guizhou Medical University,Guiyang 561113,Guizhou,China)

机构地区：[1]贵州省人民医院麻醉科,贵州贵阳550002 [2]贵州省人民医院骨科,贵州贵阳550002 [3]贵州医科大学公共卫生学院统计学教研室,贵州贵阳561113

出　　处：《贵州医药》2024年第7期1017-1022,共6页Guizhou Medical Journal

基　　金：贵州省科学技术基金(黔科合支撑[2019]2815号);贵州省人民医院博士基金(GZSYBS[2015]05号)。

摘　　要：目的探讨影响单侧髋膝关节置换术后住院时间(length of stay,LOS)的围术期因素。方法通过筛选纳入我院行单侧髋或膝关节置换术的患者1490例;记录术前一般情况、合并症、药物使用、手术方式、手术医生、麻醉方式、麻醉用药、手术时间、液体出入量和种类等相关参数;采用单因素、多因素线性回归模型,分析患者关节置换术后影响LOS的因素。结果术后LOS为(9.63±5.13)d;THA、TKA和股骨头置换术后LOS分别为(8.80±4.70)d、(10.25±4.41)d和(11.94±7.09)d;手术时长(97.00±43.00)min;术后情况有急性肾功能损伤(AKI)80例(5.4%)、转入ICU病房99例(6.6%)、死亡5例(0.3%);其中年龄(P<0.001)、术前合并肺部感染(P=0.004)、手术医生的手术量和工作年限(P<0.001)、术中异体红细胞输注(P=0.028)、手术时长(P<0.001)、术后进入ICU(P<0.001)及术后发生AKI(P=0.047)与LOS的变化有显著相关性;术中异体红细胞输注患者LOS增加2 d;术后入住ICU比未入住者LOS延长4 d;术后发生AKI的患者LOS增加3 d。结论年龄>70岁、术前合并肺部感染、手术时间>120 min、工作年限短和年手术量少的手术医生、术中输注红细胞、术后转入ICU以及发生AKI是髋膝关节置换术后LOS增加的独立风险因素。Objective To investigate the perioperative factors influencing length of stay(LOS)after unilateral hip and knee arthroplasty.Methods A total of 1490 patients undergoing unilateral hip or knee arthroplasty were selected and included in our hospital.Preoperative general conditions,comorbidities,drug use,operation mode,surgeon,anesthesia mode,anesthetic drug,operation time,fluid intake and outflow and type were recorded.Univariate and multifactorial linear regression models were used to analyze the factors affecting LOS after joint replacement.Results The postoperative LOS was(9.63±5.13)days.The LOS after THA,TKA and femoral head replacement were(8.80±4.70)days,(10.25±4.41)days and(11.94±7.09)days,respectively.The operation duration was(97±43)min.There were 80 patients(5.4%)with acute renal function injury(AKI),99 patients(6.6%)transferred to ICU,and 5 patients(0.3%)died.Among them,age(P<0.001),preoperative pulmonary infection(P=0.004),surgical quantity and working years of the surgeon(P<0.001),intraoperative allogenic red blood cell infusion(P=0.028),operation duration(P<0.001),postoperative ICU admission(P<0.001)and postoperative AKI occurrence(P=0.047)were highly significantly associated with increasing LOS.LOS increased for 2 days after transfusion of allogeneic red blood cells.The LOS of postoperative ICU admission was 4 days longer than that of non-ICU admission.Patients with postoperative AKI experienced a 3-day increase in LOS.Conclusion Age>70 years old,preoperative pulmonary infection,operative time>120 min,short working experience and less annual operation volume,intraoperative red blood cell infusion,postoperative ICU transfer,and AKI were independent risk factors for increased LOS after hip/knee replacement.

关 键 词：住院时间 预测因素 髋关节置换术 膝关节置换术 

分 类 号：R816.8[医药卫生—放射医学]